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Patient Health Questionnaire-9 Scores Do Not Accurately Estimate Depression Prevalence: Individual Participant Data Meta-Analysis Publisher Pubmed



Levis B1, 2 ; Benedetti A2, 3, 4 ; Ioannidis JPA5, 6, 7, 8 ; Sun Y1 ; Negeri Z1, 2 ; He C1 ; Wu Y1, 2, 9 ; Krishnan A1 ; Bhandari PM1, 2 ; Neupane D1, 2 ; Imran M1 ; Rice DB1, 10 ; Riehm KE1, 11 ; Saadat N1 Show All Authors
Authors
  1. Levis B1, 2
  2. Benedetti A2, 3, 4
  3. Ioannidis JPA5, 6, 7, 8
  4. Sun Y1
  5. Negeri Z1, 2
  6. He C1
  7. Wu Y1, 2, 9
  8. Krishnan A1
  9. Bhandari PM1, 2
  10. Neupane D1, 2
  11. Imran M1
  12. Rice DB1, 10
  13. Riehm KE1, 11
  14. Saadat N1
  15. Azar M1, 2
  16. Boruff J12
  17. Cuijpers P13
  18. Gilbody S14
  19. Kloda LA15
  20. Mcmillan D11
  21. Patten SB16, 17
  22. Shrier I1, 2, 18
  23. Ziegelstein RC19
  24. Alamri SH20
  25. Amtmann D21
  26. Ayalon L22
  27. Baradaran HR23, 24
  28. Beraldi A25
  29. Bernstein CN26, 27
  30. Bhana A28, 29
  31. Bombardier CH21
  32. Carter G30
  33. Chagas MH31
  34. Chibanda D32
  35. Clover K30
  36. Conwell Y33
  37. Diezquevedo C34, 35
  38. Fann JR36
  39. Fischer FH9, 37
  40. Gholizadeh L38
  41. Gibson LJ39
  42. Green EP40
  43. Greeno CG41
  44. Hall BJ42, 43
  45. Haroz EE44
  46. Ismail K45
  47. Jette N16, 17, 46
  48. Khamseh ME23
  49. Kwan Y47
  50. Lara MA48
  51. Liu SI49, 50, 51, 52
  52. Loureiro SR31
  53. Lowe B53
  54. Marrie RA54
  55. Marsh L55
  56. Mcguire A56
  57. Muramatsu K57
  58. Navarrete L58
  59. Osorio FL31, 59
  60. Petersen I60
  61. Picardi A61
  62. Pugh SL62, 63
  63. Quinn TJ64
  64. Rooney AG65
  65. Shinn EH66
  66. Sidebottom A67
  67. Spangenberg L68
  68. Tan PLL47
  69. Taylorrowan M69
  70. Turner A70, 71
  71. Van Weert HC72
  72. Vohringer PA73, 74, 75
  73. Wagner LI76, 77
  74. White J78
  75. Winkley K79
  76. Thombs BD1, 2, 4, 9, 10, 80, 81
Show Affiliations
Authors Affiliations
  1. 1. Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
  2. 2. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  3. 3. Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
  4. 4. Department of Medicine, McGill University, Montreal, Quebec, Canada
  5. 5. Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
  6. 6. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States
  7. 7. Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, United States
  8. 8. Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, United States
  9. 9. Department of Psychiatry, McGill University, Montreal, Quebec, Canada
  10. 10. Department of Psychology, McGill University, Montreal, Quebec, Canada
  11. 11. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
  12. 12. Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
  13. 13. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  14. 14. Hull York Medical School and the Department of Health Sciences, University of York, Heslington, NY, United Kingdom
  15. 15. Library, Concordia University, Montreal, Quebec, Canada
  16. 16. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  17. 17. Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
  18. 18. Department of Family Medicine, McGill University, Montreal, Quebec, Canada
  19. 19. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  20. 20. Faculty of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
  21. 21. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
  22. 22. Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
  23. 23. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
  24. 24. Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
  25. 25. Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Klinik fur Psychiatrie, Psychotherapie & Psychosomatik, Lehrkrankenhaus der Technischen Universitat Munchen, Munich, Germany
  26. 26. University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
  27. 27. Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  28. 28. Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
  29. 29. Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
  30. 30. Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
  31. 31. Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
  32. 32. Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
  33. 33. Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
  34. 34. Servei de Psiquiatria, Hospital Germans Trias i Pujol, Badalona, Spain
  35. 35. Departament de Psiquiatria i Medicina Legal, Universitat Autonoma de Barcelona, Badalona, Spain
  36. 36. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
  37. 37. Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charite - Universitatsmedizin Berlin, Berlin, Germany
  38. 38. Faculty of Health, University of Technology Sydney, Sydney, Australia
  39. 39. Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  40. 40. Duke Global Health Institute, Duke University, Durham, NC, United States
  41. 41. School of Social Work, University of Pittsburgh, Pittsburgh, PA, United States
  42. 42. Department of Psychology, Faculty of Social Sciences, Global and Community Mental Health Research Group, University of Macau, Macau Special Administrative Region, China
  43. 43. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
  44. 44. Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
  45. 45. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, London, United Kingdom
  46. 46. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
  47. 47. Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
  48. 48. Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz. San Lorenzo Huipulco, Tlalpan, Mexico D. F., Mexico
  49. 49. Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
  50. 50. Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
  51. 51. Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
  52. 52. Department of Medicine, Mackay Medical College, Taipei, Taiwan
  53. 53. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  54. 54. Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  55. 55. Baylor College of Medicine, Houston and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
  56. 56. Department of Nursing, St. Joseph's College, Standish, ME, United States
  57. 57. Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
  58. 58. Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz, Ciudad de Mexico, Mexico
  59. 59. National Institute of Science and Technology, Translational Medicine, Ribeirao Preto, Brazil
  60. 60. Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
  61. 61. Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
  62. 62. NRG Oncology Statistics and Data Management Center, Philadelphia, PA, United States
  63. 63. American College of Radiology, Philadelphia, PA, United States
  64. 64. Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
  65. 65. Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, United Kingdom
  66. 66. Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
  67. 67. Allina Health, Minneapolis, MN, United States
  68. 68. Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
  69. 69. Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, Scotland, United Kingdom
  70. 70. School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  71. 71. Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia
  72. 72. Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
  73. 73. Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
  74. 74. Millennium Institute for Depression and Personality Research (MIDAP), Ministry of Economy, Macul, Santiago, Chile
  75. 75. Psychiatry Department, Tufts Medical Center, Tufts University, Boston, MA, United States
  76. 76. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United States
  77. 77. Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
  78. 78. Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
  79. 79. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
  80. 80. Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
  81. 81. Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada

Source: Journal of Clinical Epidemiology Published:2020


Abstract

Objectives: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. Study Design and Setting: Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. Results: A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: −13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: −16.4%, 15.0%). Conclusion: PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies. © 2020 Elsevier Inc.
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