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



Levis B^{1, 2} ; Benedetti A^{2, 3, 4} ; Ioannidis JPA^{5, 6, 7, 8} ; Sun Y¹ ; Negeri Z^{1, 2} ; He C¹ ; Wu Y^{1, 2, 9} ; Krishnan A¹ ; Bhandari PM^{1, 2} ; Neupane D^{1, 2} ; Imran M¹ ; Rice DB^{1, 10} ; Riehm KE^{1, 11} ; Saadat N¹ Show All Authors
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.