Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis.

Abstract:

BACKGROUND: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.

journal_name

Psychol Med

journal_title

Psychological medicine

authors

Wu Y,Levis B,Riehm KE,Saadat N,Levis AW,Azar M,Rice DB,Boruff J,Cuijpers P,Gilbody S,Ioannidis JPA,Kloda LA,McMillan D,Patten SB,Shrier I,Ziegelstein RC,Akena DH,Arroll B,Ayalon L,Baradaran HR,Baron M,Bombardier

doi

10.1017/S0033291719001314

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

1368-1380

issue

8

eissn

0033-2917

issn

1469-8978

pii

S0033291719001314

journal_volume

50

pub_type

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