Meta-analysis Update: How accurate is the PHQ-9 Depression Screening Tool?
BACKGROUND AND PURPOSE:
The Patient Health Questionnaire-9 (PHQ-9) is a depression screening tool commonly used in general practice, and recommended by USPTF and other groups
Negeri et al. (BMJ, 2021) updated a previous analysis to determine the accuracy of the PHQ-9 for detecting major depression
Systematic review and individual participant datameta-analysis
Study inclusion criteria
PHQ-9 administered with major depression status diagnosis based on validated semistructured or fully structured interview conducted within two weeks of PHQ-9 administration
Bivariate random effects meta-analytic model used for pooled PHQ-9 sensitivity and specificity at cut-off values 5 to 15
Diagnostic interviews: Semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual) | Fully structured interviews (eg, Composite International Diagnostic Interview) | The MINI interview
44,503 participants (27,146 participants were added in this update)
100 studies (42 studies added in this update)
PHQ-9 sensitivity and specificity was highest with a semistructured interview reference standard at the standard cut-off value of ≥10
Sensitivity: 0.85 (95% CI, 0.79 to 0.89)
Specificity: 0.85 (95% CI, 0.82 to 0.87)
Sensitivity was higher with semistructured interview standard
Semistructured interviews vs fully structured interviews: 7 to 24% (median 21%) higher
Semistructured interviews vs MINI: 2 to 14% (median 11%) higher
Across reference standards and cut-off values, specificity was higher for men and people aged 60 and older
Men: 0 to 10% (median 3%) higher
Aged ≥60 years: 0 to 12% (median 5%) higher
Specificity was generally similar across reference standards
PHQ-9 sensitivity and specificity for major depression was maximized at a cut-off of 10 when compared to a semistructured interview reference standard
PHQ-9 specificity was higher for men and in older individuals
The authors state
Researchers and clinicians can choose a cut-off value based on clinical priorities and local resources by comparing screening outcomes that would occur with different outcomes, including true and false positive screens and true and false negative results
A knowledge translation tool based on the findings from this study can be used to generate screening outcomes for different cut-off values based on local assumptions about prevalence
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