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Equivalency of the Diagnostic Accuracy of the Phq-8 and Phq-9: A Systematic Review and Individual Participant Data Meta-Analysis Publisher Pubmed



Wu Y1, 2, 3 ; Levis B1, 3 ; Riehm KE1 ; Saadat N1 ; Levis AW1 ; Azar M1 ; Rice DB1, 4 ; Boruff J5 ; Cuijpers P6 ; Gilbody S7 ; Ioannidis JPA8 ; Kloda LA9 ; Mcmillan D7 ; Patten SB10, 11 Show All Authors
Authors
  1. Wu Y1, 2, 3
  2. Levis B1, 3
  3. Riehm KE1
  4. Saadat N1
  5. Levis AW1
  6. Azar M1
  7. Rice DB1, 4
  8. Boruff J5
  9. Cuijpers P6
  10. Gilbody S7
  11. Ioannidis JPA8
  12. Kloda LA9
  13. Mcmillan D7
  14. Patten SB10, 11
  15. Shrier I1, 3
  16. Ziegelstein RC12
  17. Akena DH13
  18. Arroll B14
  19. Ayalon L15
  20. Baradaran HR16, 17
  21. Baron M1, 18
  22. Bombardier CH19
  23. Butterworth P20, 21
  24. Carter G22
  25. Chagas MH23
  26. Chan JCN24, 25, 26
  27. Cholera R27
  28. Conwell Y28
  29. De Manvan Ginkel JM29
  30. Fann JR30
  31. Fischer FH31
  32. Fung D32, 33, 34, 35
  33. Gelaye B36
  34. Goodyearsmith F14
  35. Greeno CG37
  36. Hall BJ38, 39
  37. Harrison PA40
  38. Harter M41
  39. Hegerl U42
  40. Hides L43
  41. Hobfoll SE44
  42. Hudson M1, 18
  43. Hyphantis T45
  44. Inagaki M46
  45. Jette N10, 11, 47
  46. Khamseh ME16
  47. Kiely KM48, 49
  48. Kwan Y50
  49. Lamers F51
  50. Liu SI35, 52, 53, 54
  51. Lotrakul M55
  52. Loureiro SR23
  53. Lowe B56
  54. Mcguire A57
  55. Mohdsidik S58
  56. Munhoz TN59
  57. Muramatsu K60
  58. Osorio FL23, 61
  59. Patel V62, 63
  60. Pence BW64
  61. Persoons P65, 66
  62. Picardi A67
  63. Reuter K68
  64. Rooney AG69
  65. Santos IS59
  66. Shaaban J70
  67. Sidebottom A71
  68. Simning A28
  69. Stafford L72, 73
  70. Sung S32, 35
  71. Tan PLL50
  72. Turner A74, 75
  73. Van Weert HC76
  74. White J77
  75. Whooley MA78, 79, 80
  76. Winkley K81
  77. Yamada M82
  78. Benedetti A3, 18, 83
  79. Thombs BD1, 2, 3, 4, 18, 84
Show Affiliations
Authors Affiliations
  1. 1. Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
  2. 2. Department of Psychiatry, McGill University, Montreal, QC, Canada
  3. 3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
  4. 4. Department of Psychology, McGill University, Montreal, QC, Canada
  5. 5. Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, QC, Canada
  6. 6. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
  7. 7. Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, United Kingdom
  8. 8. Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, CA, United States
  9. 9. Library, Concordia University, Montreal, QC, Canada
  10. 10. Department of Community Health Sciences, University of Calgary, Calgary, AL, Canada
  11. 11. Hotchkiss Brain Institute and o'Brien Institute for Public Health, University of Calgary, Calgary, AL, Canada
  12. 12. Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
  13. 13. Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
  14. 14. Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
  15. 15. Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
  16. 16. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
  17. 17. Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
  18. 18. Department of Medicine, McGill University, Montreal, QC, Canada
  19. 19. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
  20. 20. Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australia
  21. 21. Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
  22. 22. Centre for Brain and Mental Health Research, University of Newcastle, NSW, Australia
  23. 23. Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
  24. 24. Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
  25. 25. Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong, Hong Kong
  26. 26. Hong Kong Institute of Diabetes and Obesity, Hong Kong, Hong Kong
  27. 27. Department of Pediatrics, University of North Carolina, Chapel Hill School of Medicine, Chapel Hill, NC, United States
  28. 28. Department of Psychiatry, University of Rochester Medical Center, New York, United States
  29. 29. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
  30. 30. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
  31. 31. Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charite - Universitatsmedizin Berlin, Berlin, Germany
  32. 32. Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore
  33. 33. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  34. 34. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
  35. 35. Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
  36. 36. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
  37. 37. School of Social Work, University of Pittsburgh, Pittsburgh, PA, United States
  38. 38. Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macao
  39. 39. Department of Health, Behavior and Society Johns Hopkins Bloomberg, School of Public Health, Baltimore, MD, United States
  40. 40. City of Minneapolis Health Department, Minneapolis, MN, United States
  41. 41. Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  42. 42. Depression Research Center of the German Depression Foundation and Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
  43. 43. School of Psychology, University of Queensland, Brisbane, QLD, Australia
  44. 44. STAR-Stress, Anxiety and Resilience Consultants, Chicago, IL, United States
  45. 45. Department of Psychiatry, University of Ioannina, Ioannina, Greece
  46. 46. Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
  47. 47. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
  48. 48. School of Psychology, University of New South Wales, Sydney, Australia
  49. 49. Neuroscience Research Australia, Sydney, Australia
  50. 50. Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
  51. 51. Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
  52. 52. Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
  53. 53. Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
  54. 54. Department of Medicine, Mackay Medical College, Taipei, Taiwan
  55. 55. Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  56. 56. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  57. 57. Department of Nursing, St. Joseph's College, Standish, ME, United States
  58. 58. Department of Psychiatry, Faculty of Medicine and Health Sciences, Cancer Resource and Education Centre, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
  59. 59. Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
  60. 60. Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
  61. 61. National Institute of Science and Technology, Translational Medicine, Ribeirao Preto, Brazil
  62. 62. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
  63. 63. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
  64. 64. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
  65. 65. Department of Adult Psychiatry, University Hospitals Leuven, Leuven, Belgium
  66. 66. Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
  67. 67. Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
  68. 68. Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
  69. 69. Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, United Kingdom
  70. 70. Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
  71. 71. Allina Health, Minneapolis, MN, United States
  72. 72. Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Melbourne, Australia
  73. 73. Melbourne School of Psychological Sciences, University of Melbourne, Australia
  74. 74. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  75. 75. IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
  76. 76. Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
  77. 77. Monash University, Melbourne, Australia
  78. 78. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
  79. 79. Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA, United States
  80. 80. Department of Medicine, University of California San Francisco, San Francisco, CA, United States
  81. 81. Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
  82. 82. Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi, Kodaira, Tokyo, Japan
  83. 83. Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada
  84. 84. Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada

Source: Psychological Medicine Published:2020


Abstract

Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.Methods We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.Results 16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).Conclusions PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar. Copyright © Cambridge University Press 2019.