The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis

Chen He; Brooke Levis; Kira E. Riehm; Nazanin Saadat; Alexander W. Levis; Marleine Azar; Danielle B. Rice; Ankur Krishnan; Yin Wu; Ying Sun; Mahrukh Imran; Jill Boruff; Pim Cuijpers; Simon Gilbody; John P.A. Ioannidis; Lorie A. Kloda; Dean McMillan; Scott B. Patten; Ian Shrier; Roy C. Ziegelstein; Dickens H. Akena; Bruce Arroll; Liat Ayalon; Hamid R. Baradaran; Murray Baron; Anna Beraldi; Charles H. Bombardier; Peter Butterworth; Gregory Carter; Marcos Hortes Nisihara Chagas; Juliana C.N. Chan; Rushina Cholera; Kerrie Clover; Yeates Conwell; Janneke M. De Man-Van Ginkel; Jesse R. Fann; Felix H. Fischer; Daniel Fung; Bizu Gelaye; Felicity Goodyear-Smith; Catherine G. Greeno; Brian J. Hall; Patricia A. Harrison; Martin Härter; Ulrich Hegerl; Leanne Hides; Stevan E. Hobfoll; Marie Hudson; Thomas N. Hyphantis; Masatoshi Inagaki; Khalida Ismail; Nathalie Jetté; Mohammad E. Khamseh; Kim M. Kiely; Yunxin Kwan; Femke Lamers; Shen Ing Liu; Manote Lotrakul; Sonia R. Loureiro; Bernd Löwe; Laura Marsh; Anthony McGuire; Sherina Mohd-Sidik; Tiago N. Munhoz; Kumiko Muramatsu; Flávia L. Osório; Vikram Patel; Brian W. Pence; Philippe Persoons; Angelo Picardi; Katrin Reuter; Alasdair G. Rooney; Iná S. Da Silva Dos Santos; Juwita Shaaban; Abbey Sidebottom; Adam Simning; Lesley Stafford; Sharon Sung; Pei Lin Lynnette Tan; Alyna Turner; Henk C.P.M. Van Weert; Jennifer White; Mary A. Whooley; Kirsty Winkley; Mitsuhiko Yamada; Brett D. Thombs; Andrea Benedetti

doi:10.1159/000502294

The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis

Chen He, Brooke Levis, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Ankur Krishnan, Yin Wu, Ying Sun, Mahrukh Imran, Jill Boruff, Pim Cuijpers, Simon Gilbody, John P.A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Roy C. ZiegelsteinDickens H. Akena, Bruce Arroll, Liat Ayalon, Hamid R. Baradaran, Murray Baron, Anna Beraldi, Charles H. Bombardier, Peter Butterworth, Gregory Carter, Marcos Hortes Nisihara Chagas, Juliana C.N. Chan, Rushina Cholera, Kerrie Clover, Yeates Conwell, Janneke M. De Man-Van Ginkel, Jesse R. Fann, Felix H. Fischer, Daniel Fung, Bizu Gelaye, Felicity Goodyear-Smith, Catherine G. Greeno, Brian J. Hall, Patricia A. Harrison, Martin Härter, Ulrich Hegerl, Leanne Hides, Stevan E. Hobfoll, Marie Hudson, Thomas N. Hyphantis, Masatoshi Inagaki, Khalida Ismail, Nathalie Jetté, Mohammad E. Khamseh, Kim M. Kiely, Yunxin Kwan, Femke Lamers, Shen Ing Liu, Manote Lotrakul, Sonia R. Loureiro, Bernd Löwe, Laura Marsh, Anthony McGuire, Sherina Mohd-Sidik, Tiago N. Munhoz, Kumiko Muramatsu, Flávia L. Osório, Vikram Patel, Brian W. Pence, Philippe Persoons, Angelo Picardi, Katrin Reuter, Alasdair G. Rooney, Iná S. Da Silva Dos Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Lesley Stafford, Sharon Sung, Pei Lin Lynnette Tan, Alyna Turner, Henk C.P.M. Van Weert, Jennifer White, Mary A. Whooley, Kirsty Winkley, Mitsuhiko Yamada, Brett D. Thombs, Andrea Benedetti

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

67 Citations (Scopus)

Abstract

Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.

Original language	English
Pages (from-to)	25-37
Number of pages	13
Journal	Psychotherapy and Psychosomatics
Volume	89
Early online date	8 Oct 2019
DOIs	https://doi.org/10.1159/000502294
Publication status	Published - 2020

Bibliographical note

Funding Sources
This study was funded by the Canadian Institutes of Health Research (CIHR; KRS-134297, PCG-155468). Ms. Levis was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship doctoral award. Ms. Riehm and Ms. Saadat were supported by CIHR Frederick Banting and Charles Best Canadian Graduate Scholarships – Master’s Awards. Mr. Levis and Ms. Azar were supported by FRQS Masters Training Awards. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Dr. Wu was supported by an Utting Postdoctoral Fellowship from the Jewish General Hospital, Montreal, Quebec, QC, Canada. Collection of data for the study by Arroll et al. was supported by a project grant from the Health Research Council of New Zealand. Data collection for the study by Ayalon et al. was supported from a grant from Lundbeck International. The primary study by Khamseh et al. was supported by a grant (M-288) from Tehran University of Medical Sciences. The primary study by Bombardier et al. was supported by the Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington (grant No. H133N060033), Baylor College of Medicine (grant No. H133N060003), and University of Michigan (grant No. H133N060032). Dr. Butterworth was supported by Australian Research Council Future Fellowship FT130101444. Dr. Cholera was supported by a United States National Institute of Mental Health (NIMH) grant (5F30MH096664), and the United States National Institutes of Health (NIH) Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium (1R25TW00934001) and the American Recovery and Reinvestment Act. Dr. Conwell received support from NIMH (R24MH071604) and the Centers for Disease Control and Prevention (R49 CE002093). The primary studies by Amoozegar and by Fiest et al. were funded by the Alberta Health Services, the University of Calgary Faculty of Medicine, and the Hotchkiss Brain Institute. The primary study by Fischer et al. was funded by the German Federal Ministry of Education and Research (01GY1150). Data for the primary study by Gelaye et al. was supported by a grant from the NIH (T37 MD001449). Collection of data for the primary study by Gjerdingen et al. was supported by grants from the NIMH (R34 MH072925, K02 MH65919, P30 DK50456). The primary study by Eack et al. was funded by the NIMH (R24 MH56858). Collection of data provided by Drs. Härter and Reuter was supported by the Federal Ministry of Education and Research (grants No. 01 GD 9802/4 and 01 GD 0101) and by the Federation of German Pension Insurance Institute. Collection of data for the primary study by Hobfoll et al. was made possible in part from grants from NIMH (RO1 MH073687) and the Ohio Board of Regents. Dr. Hall received support from a grant awarded by the Research and Development Administration Office, University of Macau (MYRG2015-00109-FSS). The primary study by Hides et al. was funded by the Perpetual Trustees, Flora and Frank Leith Charitable Trust, Jack Brockhoff Foundation, Grosvenor Settlement, Sunshine Foundation and Danks Trust. The primary study by Henkel et al. was funded by the German Ministry of Research and Education. Data for the study by Razykov et al. was collected by the Canadian Scleroderma Research Group, which was funded by the CIHR (FRN 83518), the Scleroderma Society of Canada, the Scleroderma Society of Ontario, the Scleroderma Society of Saskatchewan, Sclérodermie Québec, the Cure Scleroderma Foundation, Inova Diagnostics Inc., Euroimmun, FRQS, the Canadian Arthritis Network, and the Lady Davis Institute of Medical Research of the Jewish General Hospital, Montreal, QC, Canada. Dr. Hudson was supported by a FRQS Senior Investigator Award. Collection of data for the primary study by Hyphantis et al. was supported by a grant from the National Strategic Reference Framework, European Union, and the Greek Ministry of Education, Lifelong Learning and Religious Affairs (ARISTEIA-ABREVIATE, 1259). The primary study by Inagaki et al. was supported by the Ministry of Health, Labour and Welfare, Japan. Dr. Jetté was supported by a Canada Research Chair in Neurological Health Services Research. Collection of data for the primary study by Kiely et al. was supported by National Health and Medical Research Council (grant No. 1002160) and Safe Work Australia. Dr. Kiely was supported by funding from an Australian National Health and Medical Research Council fellowship (grant No. 1088313). The primary study by Lamers et al. was funded by the Netherlands Organisation for Health Research and development (grant No. 945-03-047). The primary study by Liu et al. was funded by a grant from the National Health Research Institute, Republic of China (NHRI-EX97–9706PI). The primary study by Lotrakul et al. was supported by the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (grant No. 49086). Dr. Bernd Löwe received research grants from Pfizer, Germany, and from the medical faculty of the University of Heidelberg, Germany (project 121/2000) for the study by Gräfe et al. The primary study by Mohd-Sidik et al. was funded under the Research University Grant Scheme from Universiti Putra Malaysia, Malaysia, and the Postgraduate Research Student Support Accounts of the University of Auckland, New Zealand. The primary study by Santos et al. was funded by the National Program for Centers of Excellence (PRONEX/FAPERGS/CNPq, Brazil). The primary study by Muramatsu et al. was supported by an educational grant from Pfizer US Pharmaceutical Inc. Collection of primary data for the study by Dr. Pence was provided by NIMH (R34MH084673). The primary studies by Osório et al. were funded by Reitoria de Pesquisa da Universidade de São Paulo (grant No. 09.1.01689.17.7) and Banco Santander (grant No. 10.1.01232.17.9). Dr. Osório was supported by Productivity Grants (PQ-CNPq-2 No. 301321/2016-7). The primary study by Picardi et al. was supported by funds for current research from the Italian Ministry of Health. Dr. Persoons was supported by a grant from the Belgian Ministry of Public Health and Social Affairs and a restricted grant from Pfizer Belgium. Dr. Shaaban was supported by funding from Universiti Sains Malaysia. The primary study by Rooney et al. was funded by the United Kingdom National Health Service Lothian Neuro-Oncology Endowment Fund. The primary study by Sidebottom et al. was funded by a grant from the United States Department of Health and Human Services, Health Resources and Services Administration (grant No. R40MC07840). Simning et al.’s research was supported in part by grants from the NIH (T32 GM07356), Agency for Healthcare Research and Quality (R36 HS018246), NIMH (R24 MH071604), and the National Center for Research Resources (TL1 RR024135). Dr. Stafford received PhD scholarship funding from the University of Melbourne. Collection of data for the studies by Turner et al. were funded by a bequest from Jennie Thomas through the Hunter Medical Research Institute. Collection of data for the primary study by Williams et al. was supported by a NIMH grant to Dr. Marsh (RO1-MH069666). The primary study by Thombs et al. was done with data from the Heart and Soul Study (PI Mary Whooley). The Heart and Soul Study was funded by the Department of Veterans Epidemiology Merit Review Program, the Department of Veterans Affairs Health Services Research and Development Service, the National Heart Lung and Blood Institute (R01 HL079235), the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Ischemia Research and Education Foundation. Dr. Thombs was supported by an Investigator Award from the Arthritis Society. The primary study by Twist et al. was funded by the UK National Institute for Health Research under its Programme Grants for Applied Research Programme (grant reference No. RP-PG-0606-1142). The study by Wittkampf et al. was funded by The Netherlands Organization for Health Research and Development (ZonMw) Mental Health Program (No. 100.003.005 and 100.002.021) and the Academic Medical Center/University of Amsterdam. Collection of data for the primary study by Zhang et al. was supported by the European Foundation for Study of Diabetes, the Chinese Diabetes Society, Lilly Foundation, Asia Diabetes Foundation, and Liao Wun Yuk Diabetes Memorial Fund. Drs. Thombs and Benedetti were supported by Fonds de recherche du Québec – Santé (FRQS) researcher salary awards. No other authors reported funding for primary studies or for their work on the present study.

Author Contributions
C.H., B. Levis, J.B., P.C., S.G., J.P.A.I., L.A.K., D.M., S.B.P., I.S., R.J.S., R.C.Z., B.D.T., and A. Benedetti were responsible for the study conception and design. J.B. and L.A.K. designed and conducted database searches to identify eligible studies. D.H.A., B.A., L.A., H.R.B., M.B., A. Beraldi, C.H.B., H.B., P.B., G.C., M.H.C., J.C.N.C., R.C., K.C., Y.C., J.M.G., J.R.F., F.H.F., D.F., B.G., F.G.S., C.G.G., B.J.H., J.H., P.A.H., M. Härter, U.H., L.H., S.E.H., M. Hudson, T.H., M. Inagaki, K.I., N.J., M.E.K., K.M.K., Y.K., F.L., S.L., M.L., S.R.L., B. Löwe, L.M., A.M., S.M., T.N.M., K.M., F.L.O., V.P., B.W.P., P.P., A.P., K.R., A.G.R., I.S.S., J.S., A. Sidebottom, A. Simning, L.S., S.S., P.L.L.T., A.T., H.C.W., J.W., M.A.W., K.W., K.A.W., M.Y., and B.D.T. were responsible for collection of primary data included in this study. C.H., B. Levis, K.E.R., N.S., A.W.L., M.A., D.B.R., A.K., Y.W., Y.S., M. Imran, and B.D.T. contributed to data extraction and coding for the meta-analysis. C.H., B. Levis, B.D.T., and A.Benedetti contributed to the data analysis and interpretation. C.H., B. Levis, B.D.T., and A. Benedetti contributed to drafting the manuscript. All authors provided a critical review and approved the final paper. B.D.T. and A. Benedetti are the guarantors.

Keywords

Depression
Diagnostic accuracy
Meta-analysis
Patient Health Questionnaire-9
Screening
CLINIMETRICS
PERFORMANCE
PREVALENCE
PHQ-9
PRIMARY-CARE
INVENTORY
RECOMMENDATIONS
INTERNATIONAL DIAGNOSTIC INTERVIEW
VALIDITY
SEVERITY

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

He, C., Levis, B., Riehm, K. E., Saadat, N., Levis, A. W., Azar, M., Rice, D. B., Krishnan, A., Wu, Y., Sun, Y., Imran, M., Boruff, J., Cuijpers, P., Gilbody, S., Ioannidis, J. P. A., Kloda, L. A., McMillan, D., Patten, S. B., Shrier, I., ... Benedetti, A. (2020). The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis. Psychotherapy and Psychosomatics, 89, 25-37. https://doi.org/10.1159/000502294

He, C, Levis, B, Riehm, KE, Saadat, N, Levis, AW, Azar, M, Rice, DB, Krishnan, A, Wu, Y, Sun, Y, Imran, M, 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, Beraldi, A, Bombardier, CH, Butterworth, P, Carter, G, Chagas, MHN, Chan, JCN, Cholera, R, Clover, K, Conwell, Y, De Man-Van Ginkel, JM, Fann, JR, Fischer, FH, Fung, D, Gelaye, B, Goodyear-Smith, F, Greeno, CG, Hall, BJ, Harrison, PA, Härter, M, Hegerl, U, Hides, L, Hobfoll, SE, Hudson, M, Hyphantis, TN, Inagaki, M, Ismail, K, Jetté, N, Khamseh, ME, Kiely, KM, Kwan, Y, Lamers, F, Liu, SI, Lotrakul, M, Loureiro, SR, Löwe, B, Marsh, L, McGuire, A, Mohd-Sidik, S, Munhoz, TN, Muramatsu, K, Osório, FL, Patel, V, Pence, BW, Persoons, P, Picardi, A, Reuter, K, Rooney, AG, Da Silva Dos Santos, IS, Shaaban, J, Sidebottom, A, Simning, A, Stafford, L, Sung, S, Tan, PLL, Turner, A, Van Weert, HCPM, White, J, Whooley, MA, Winkley, K, Yamada, M, Thombs, BD & Benedetti, A 2020, 'The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis', Psychotherapy and Psychosomatics, vol. 89, pp. 25-37. https://doi.org/10.1159/000502294

@article{04b70dbbc0504be7a695fdd97f71cb30,

title = "The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis",

abstract = "Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.",

keywords = "Depression, Diagnostic accuracy, Meta-analysis, Patient Health Questionnaire-9, Screening, CLINIMETRICS, PERFORMANCE, PREVALENCE, PHQ-9, PRIMARY-CARE, INVENTORY, RECOMMENDATIONS, INTERNATIONAL DIAGNOSTIC INTERVIEW, VALIDITY, SEVERITY",

author = "Chen He and Brooke Levis and Riehm, {Kira E.} and Nazanin Saadat and Levis, {Alexander W.} and Marleine Azar and Rice, {Danielle B.} and Ankur Krishnan and Yin Wu and Ying Sun and Mahrukh Imran and Jill Boruff and Pim Cuijpers and Simon Gilbody and Ioannidis, {John P.A.} and Kloda, {Lorie A.} and Dean McMillan and Patten, {Scott B.} and Ian Shrier and Ziegelstein, {Roy C.} and Akena, {Dickens H.} and Bruce Arroll and Liat Ayalon and Baradaran, {Hamid R.} and Murray Baron and Anna Beraldi and Bombardier, {Charles H.} and Peter Butterworth and Gregory Carter and Chagas, {Marcos Hortes Nisihara} and Chan, {Juliana C.N.} and Rushina Cholera and Kerrie Clover and Yeates Conwell and {De Man-Van Ginkel}, {Janneke M.} and Fann, {Jesse R.} and Fischer, {Felix H.} and Daniel Fung and Bizu Gelaye and Felicity Goodyear-Smith and Greeno, {Catherine G.} and Hall, {Brian J.} and Harrison, {Patricia A.} and Martin H{\"a}rter and Ulrich Hegerl and Leanne Hides and Hobfoll, {Stevan E.} and Marie Hudson and Hyphantis, {Thomas N.} and Masatoshi Inagaki and Khalida Ismail and Nathalie Jett{\'e} and Khamseh, {Mohammad E.} and Kiely, {Kim M.} and Yunxin Kwan and Femke Lamers and Liu, {Shen Ing} and Manote Lotrakul and Loureiro, {Sonia R.} and Bernd L{\"o}we and Laura Marsh and Anthony McGuire and Sherina Mohd-Sidik and Munhoz, {Tiago N.} and Kumiko Muramatsu and Os{\'o}rio, {Fl{\'a}via L.} and Vikram Patel and Pence, {Brian W.} and Philippe Persoons and Angelo Picardi and Katrin Reuter and Rooney, {Alasdair G.} and {Da Silva Dos Santos}, {In{\'a} S.} and Juwita Shaaban and Abbey Sidebottom and Adam Simning and Lesley Stafford and Sharon Sung and Tan, {Pei Lin Lynnette} and Alyna Turner and {Van Weert}, {Henk C.P.M.} and Jennifer White and Whooley, {Mary A.} and Kirsty Winkley and Mitsuhiko Yamada and Thombs, {Brett D.} and Andrea Benedetti",

note = "Funding Sources This study was funded by the Canadian Institutes of Health Research (CIHR; KRS-134297, PCG-155468). Ms. Levis was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship doctoral award. Ms. Riehm and Ms. Saadat were supported by CIHR Frederick Banting and Charles Best Canadian Graduate Scholarships – Master{\textquoteright}s Awards. Mr. Levis and Ms. Azar were supported by FRQS Masters Training Awards. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Dr. Wu was supported by an Utting Postdoctoral Fellowship from the Jewish General Hospital, Montreal, Quebec, QC, Canada. Collection of data for the study by Arroll et al. was supported by a project grant from the Health Research Council of New Zealand. Data collection for the study by Ayalon et al. was supported from a grant from Lundbeck International. The primary study by Khamseh et al. was supported by a grant (M-288) from Tehran University of Medical Sciences. The primary study by Bombardier et al. was supported by the Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington (grant No. H133N060033), Baylor College of Medicine (grant No. H133N060003), and University of Michigan (grant No. H133N060032). Dr. Butterworth was supported by Australian Research Council Future Fellowship FT130101444. Dr. Cholera was supported by a United States National Institute of Mental Health (NIMH) grant (5F30MH096664), and the United States National Institutes of Health (NIH) Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women{\textquoteright}s Health through the Fogarty Global Health Fellows Program Consortium (1R25TW00934001) and the American Recovery and Reinvestment Act. Dr. Conwell received support from NIMH (R24MH071604) and the Centers for Disease Control and Prevention (R49 CE002093). The primary studies by Amoozegar and by Fiest et al. were funded by the Alberta Health Services, the University of Calgary Faculty of Medicine, and the Hotchkiss Brain Institute. The primary study by Fischer et al. was funded by the German Federal Ministry of Education and Research (01GY1150). Data for the primary study by Gelaye et al. was supported by a grant from the NIH (T37 MD001449). Collection of data for the primary study by Gjerdingen et al. was supported by grants from the NIMH (R34 MH072925, K02 MH65919, P30 DK50456). The primary study by Eack et al. was funded by the NIMH (R24 MH56858). Collection of data provided by Drs. H{\"a}rter and Reuter was supported by the Federal Ministry of Education and Research (grants No. 01 GD 9802/4 and 01 GD 0101) and by the Federation of German Pension Insurance Institute. Collection of data for the primary study by Hobfoll et al. was made possible in part from grants from NIMH (RO1 MH073687) and the Ohio Board of Regents. Dr. Hall received support from a grant awarded by the Research and Development Administration Office, University of Macau (MYRG2015-00109-FSS). The primary study by Hides et al. was funded by the Perpetual Trustees, Flora and Frank Leith Charitable Trust, Jack Brockhoff Foundation, Grosvenor Settlement, Sunshine Foundation and Danks Trust. The primary study by Henkel et al. was funded by the German Ministry of Research and Education. Data for the study by Razykov et al. was collected by the Canadian Scleroderma Research Group, which was funded by the CIHR (FRN 83518), the Scleroderma Society of Canada, the Scleroderma Society of Ontario, the Scleroderma Society of Saskatchewan, Scl{\'e}rodermie Qu{\'e}bec, the Cure Scleroderma Foundation, Inova Diagnostics Inc., Euroimmun, FRQS, the Canadian Arthritis Network, and the Lady Davis Institute of Medical Research of the Jewish General Hospital, Montreal, QC, Canada. Dr. Hudson was supported by a FRQS Senior Investigator Award. Collection of data for the primary study by Hyphantis et al. was supported by a grant from the National Strategic Reference Framework, European Union, and the Greek Ministry of Education, Lifelong Learning and Religious Affairs (ARISTEIA-ABREVIATE, 1259). The primary study by Inagaki et al. was supported by the Ministry of Health, Labour and Welfare, Japan. Dr. Jett{\'e} was supported by a Canada Research Chair in Neurological Health Services Research. Collection of data for the primary study by Kiely et al. was supported by National Health and Medical Research Council (grant No. 1002160) and Safe Work Australia. Dr. Kiely was supported by funding from an Australian National Health and Medical Research Council fellowship (grant No. 1088313). The primary study by Lamers et al. was funded by the Netherlands Organisation for Health Research and development (grant No. 945-03-047). The primary study by Liu et al. was funded by a grant from the National Health Research Institute, Republic of China (NHRI-EX97–9706PI). The primary study by Lotrakul et al. was supported by the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (grant No. 49086). Dr. Bernd L{\"o}we received research grants from Pfizer, Germany, and from the medical faculty of the University of Heidelberg, Germany (project 121/2000) for the study by Gr{\"a}fe et al. The primary study by Mohd-Sidik et al. was funded under the Research University Grant Scheme from Universiti Putra Malaysia, Malaysia, and the Postgraduate Research Student Support Accounts of the University of Auckland, New Zealand. The primary study by Santos et al. was funded by the National Program for Centers of Excellence (PRONEX/FAPERGS/CNPq, Brazil). The primary study by Muramatsu et al. was supported by an educational grant from Pfizer US Pharmaceutical Inc. Collection of primary data for the study by Dr. Pence was provided by NIMH (R34MH084673). The primary studies by Os{\'o}rio et al. were funded by Reitoria de Pesquisa da Universidade de S{\~a}o Paulo (grant No. 09.1.01689.17.7) and Banco Santander (grant No. 10.1.01232.17.9). Dr. Os{\'o}rio was supported by Productivity Grants (PQ-CNPq-2 No. 301321/2016-7). The primary study by Picardi et al. was supported by funds for current research from the Italian Ministry of Health. Dr. Persoons was supported by a grant from the Belgian Ministry of Public Health and Social Affairs and a restricted grant from Pfizer Belgium. Dr. Shaaban was supported by funding from Universiti Sains Malaysia. The primary study by Rooney et al. was funded by the United Kingdom National Health Service Lothian Neuro-Oncology Endowment Fund. The primary study by Sidebottom et al. was funded by a grant from the United States Department of Health and Human Services, Health Resources and Services Administration (grant No. R40MC07840). Simning et al.{\textquoteright}s research was supported in part by grants from the NIH (T32 GM07356), Agency for Healthcare Research and Quality (R36 HS018246), NIMH (R24 MH071604), and the National Center for Research Resources (TL1 RR024135). Dr. Stafford received PhD scholarship funding from the University of Melbourne. Collection of data for the studies by Turner et al. were funded by a bequest from Jennie Thomas through the Hunter Medical Research Institute. Collection of data for the primary study by Williams et al. was supported by a NIMH grant to Dr. Marsh (RO1-MH069666). The primary study by Thombs et al. was done with data from the Heart and Soul Study (PI Mary Whooley). The Heart and Soul Study was funded by the Department of Veterans Epidemiology Merit Review Program, the Department of Veterans Affairs Health Services Research and Development Service, the National Heart Lung and Blood Institute (R01 HL079235), the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Ischemia Research and Education Foundation. Dr. Thombs was supported by an Investigator Award from the Arthritis Society. The primary study by Twist et al. was funded by the UK National Institute for Health Research under its Programme Grants for Applied Research Programme (grant reference No. RP-PG-0606-1142). The study by Wittkampf et al. was funded by The Netherlands Organization for Health Research and Development (ZonMw) Mental Health Program (No. 100.003.005 and 100.002.021) and the Academic Medical Center/University of Amsterdam. Collection of data for the primary study by Zhang et al. was supported by the European Foundation for Study of Diabetes, the Chinese Diabetes Society, Lilly Foundation, Asia Diabetes Foundation, and Liao Wun Yuk Diabetes Memorial Fund. Drs. Thombs and Benedetti were supported by Fonds de recherche du Qu{\'e}bec – Sant{\'e} (FRQS) researcher salary awards. No other authors reported funding for primary studies or for their work on the present study. Author Contributions C.H., B. Levis, J.B., P.C., S.G., J.P.A.I., L.A.K., D.M., S.B.P., I.S., R.J.S., R.C.Z., B.D.T., and A. Benedetti were responsible for the study conception and design. J.B. and L.A.K. designed and conducted database searches to identify eligible studies. D.H.A., B.A., L.A., H.R.B., M.B., A. Beraldi, C.H.B., H.B., P.B., G.C., M.H.C., J.C.N.C., R.C., K.C., Y.C., J.M.G., J.R.F., F.H.F., D.F., B.G., F.G.S., C.G.G., B.J.H., J.H., P.A.H., M. H{\"a}rter, U.H., L.H., S.E.H., M. Hudson, T.H., M. Inagaki, K.I., N.J., M.E.K., K.M.K., Y.K., F.L., S.L., M.L., S.R.L., B. L{\"o}we, L.M., A.M., S.M., T.N.M., K.M., F.L.O., V.P., B.W.P., P.P., A.P., K.R., A.G.R., I.S.S., J.S., A. Sidebottom, A. Simning, L.S., S.S., P.L.L.T., A.T., H.C.W., J.W., M.A.W., K.W., K.A.W., M.Y., and B.D.T. were responsible for collection of primary data included in this study. C.H., B. Levis, K.E.R., N.S., A.W.L., M.A., D.B.R., A.K., Y.W., Y.S., M. Imran, and B.D.T. contributed to data extraction and coding for the meta-analysis. C.H., B. Levis, B.D.T., and A.Benedetti contributed to the data analysis and interpretation. C.H., B. Levis, B.D.T., and A. Benedetti contributed to drafting the manuscript. All authors provided a critical review and approved the final paper. B.D.T. and A. Benedetti are the guarantors. ",

year = "2020",

doi = "10.1159/000502294",

language = "English",

volume = "89",

pages = "25--37",

journal = "Psychotherapy and Psychosomatics",

issn = "0033-3190",

publisher = "S. Karger AG",

}

TY - JOUR

T1 - The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression

T2 - An Individual Participant Data Meta-Analysis

AU - He, Chen

AU - Levis, Brooke

AU - Riehm, Kira E.

AU - Saadat, Nazanin

AU - Levis, Alexander W.

AU - Azar, Marleine

AU - Rice, Danielle B.

AU - Krishnan, Ankur

AU - Wu, Yin

AU - Sun, Ying

AU - Imran, Mahrukh

AU - Boruff, Jill

AU - Cuijpers, Pim

AU - Gilbody, Simon

AU - Ioannidis, John P.A.

AU - Kloda, Lorie A.

AU - McMillan, Dean

AU - Patten, Scott B.

AU - Shrier, Ian

AU - Ziegelstein, Roy C.

AU - Akena, Dickens H.

AU - Arroll, Bruce

AU - Ayalon, Liat

AU - Baradaran, Hamid R.

AU - Baron, Murray

AU - Beraldi, Anna

AU - Bombardier, Charles H.

AU - Butterworth, Peter

AU - Carter, Gregory

AU - Chagas, Marcos Hortes Nisihara

AU - Chan, Juliana C.N.

AU - Cholera, Rushina

AU - Clover, Kerrie

AU - Conwell, Yeates

AU - De Man-Van Ginkel, Janneke M.

AU - Fann, Jesse R.

AU - Fischer, Felix H.

AU - Fung, Daniel

AU - Gelaye, Bizu

AU - Goodyear-Smith, Felicity

AU - Greeno, Catherine G.

AU - Hall, Brian J.

AU - Harrison, Patricia A.

AU - Härter, Martin

AU - Hegerl, Ulrich

AU - Hides, Leanne

AU - Hobfoll, Stevan E.

AU - Hudson, Marie

AU - Hyphantis, Thomas N.

AU - Inagaki, Masatoshi

AU - Ismail, Khalida

AU - Jetté, Nathalie

AU - Khamseh, Mohammad E.

AU - Kiely, Kim M.

AU - Kwan, Yunxin

AU - Lamers, Femke

AU - Liu, Shen Ing

AU - Lotrakul, Manote

AU - Loureiro, Sonia R.

AU - Löwe, Bernd

AU - Marsh, Laura

AU - McGuire, Anthony

AU - Mohd-Sidik, Sherina

AU - Munhoz, Tiago N.

AU - Muramatsu, Kumiko

AU - Osório, Flávia L.

AU - Patel, Vikram

AU - Pence, Brian W.

AU - Persoons, Philippe

AU - Picardi, Angelo

AU - Reuter, Katrin

AU - Rooney, Alasdair G.

AU - Da Silva Dos Santos, Iná S.

AU - Shaaban, Juwita

AU - Sidebottom, Abbey

AU - Simning, Adam

AU - Stafford, Lesley

AU - Sung, Sharon

AU - Tan, Pei Lin Lynnette

AU - Turner, Alyna

AU - Van Weert, Henk C.P.M.

AU - White, Jennifer

AU - Whooley, Mary A.

AU - Winkley, Kirsty

AU - Yamada, Mitsuhiko

AU - Thombs, Brett D.

AU - Benedetti, Andrea

N1 - Funding Sources This study was funded by the Canadian Institutes of Health Research (CIHR; KRS-134297, PCG-155468). Ms. Levis was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship doctoral award. Ms. Riehm and Ms. Saadat were supported by CIHR Frederick Banting and Charles Best Canadian Graduate Scholarships – Master’s Awards. Mr. Levis and Ms. Azar were supported by FRQS Masters Training Awards. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. Dr. Wu was supported by an Utting Postdoctoral Fellowship from the Jewish General Hospital, Montreal, Quebec, QC, Canada. Collection of data for the study by Arroll et al. was supported by a project grant from the Health Research Council of New Zealand. Data collection for the study by Ayalon et al. was supported from a grant from Lundbeck International. The primary study by Khamseh et al. was supported by a grant (M-288) from Tehran University of Medical Sciences. The primary study by Bombardier et al. was supported by the Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington (grant No. H133N060033), Baylor College of Medicine (grant No. H133N060003), and University of Michigan (grant No. H133N060032). Dr. Butterworth was supported by Australian Research Council Future Fellowship FT130101444. Dr. Cholera was supported by a United States National Institute of Mental Health (NIMH) grant (5F30MH096664), and the United States National Institutes of Health (NIH) Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium (1R25TW00934001) and the American Recovery and Reinvestment Act. Dr. Conwell received support from NIMH (R24MH071604) and the Centers for Disease Control and Prevention (R49 CE002093). The primary studies by Amoozegar and by Fiest et al. were funded by the Alberta Health Services, the University of Calgary Faculty of Medicine, and the Hotchkiss Brain Institute. The primary study by Fischer et al. was funded by the German Federal Ministry of Education and Research (01GY1150). Data for the primary study by Gelaye et al. was supported by a grant from the NIH (T37 MD001449). Collection of data for the primary study by Gjerdingen et al. was supported by grants from the NIMH (R34 MH072925, K02 MH65919, P30 DK50456). The primary study by Eack et al. was funded by the NIMH (R24 MH56858). Collection of data provided by Drs. Härter and Reuter was supported by the Federal Ministry of Education and Research (grants No. 01 GD 9802/4 and 01 GD 0101) and by the Federation of German Pension Insurance Institute. Collection of data for the primary study by Hobfoll et al. was made possible in part from grants from NIMH (RO1 MH073687) and the Ohio Board of Regents. Dr. Hall received support from a grant awarded by the Research and Development Administration Office, University of Macau (MYRG2015-00109-FSS). The primary study by Hides et al. was funded by the Perpetual Trustees, Flora and Frank Leith Charitable Trust, Jack Brockhoff Foundation, Grosvenor Settlement, Sunshine Foundation and Danks Trust. The primary study by Henkel et al. was funded by the German Ministry of Research and Education. Data for the study by Razykov et al. was collected by the Canadian Scleroderma Research Group, which was funded by the CIHR (FRN 83518), the Scleroderma Society of Canada, the Scleroderma Society of Ontario, the Scleroderma Society of Saskatchewan, Sclérodermie Québec, the Cure Scleroderma Foundation, Inova Diagnostics Inc., Euroimmun, FRQS, the Canadian Arthritis Network, and the Lady Davis Institute of Medical Research of the Jewish General Hospital, Montreal, QC, Canada. Dr. Hudson was supported by a FRQS Senior Investigator Award. Collection of data for the primary study by Hyphantis et al. was supported by a grant from the National Strategic Reference Framework, European Union, and the Greek Ministry of Education, Lifelong Learning and Religious Affairs (ARISTEIA-ABREVIATE, 1259). The primary study by Inagaki et al. was supported by the Ministry of Health, Labour and Welfare, Japan. Dr. Jetté was supported by a Canada Research Chair in Neurological Health Services Research. Collection of data for the primary study by Kiely et al. was supported by National Health and Medical Research Council (grant No. 1002160) and Safe Work Australia. Dr. Kiely was supported by funding from an Australian National Health and Medical Research Council fellowship (grant No. 1088313). The primary study by Lamers et al. was funded by the Netherlands Organisation for Health Research and development (grant No. 945-03-047). The primary study by Liu et al. was funded by a grant from the National Health Research Institute, Republic of China (NHRI-EX97–9706PI). The primary study by Lotrakul et al. was supported by the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (grant No. 49086). Dr. Bernd Löwe received research grants from Pfizer, Germany, and from the medical faculty of the University of Heidelberg, Germany (project 121/2000) for the study by Gräfe et al. The primary study by Mohd-Sidik et al. was funded under the Research University Grant Scheme from Universiti Putra Malaysia, Malaysia, and the Postgraduate Research Student Support Accounts of the University of Auckland, New Zealand. The primary study by Santos et al. was funded by the National Program for Centers of Excellence (PRONEX/FAPERGS/CNPq, Brazil). The primary study by Muramatsu et al. was supported by an educational grant from Pfizer US Pharmaceutical Inc. Collection of primary data for the study by Dr. Pence was provided by NIMH (R34MH084673). The primary studies by Osório et al. were funded by Reitoria de Pesquisa da Universidade de São Paulo (grant No. 09.1.01689.17.7) and Banco Santander (grant No. 10.1.01232.17.9). Dr. Osório was supported by Productivity Grants (PQ-CNPq-2 No. 301321/2016-7). The primary study by Picardi et al. was supported by funds for current research from the Italian Ministry of Health. Dr. Persoons was supported by a grant from the Belgian Ministry of Public Health and Social Affairs and a restricted grant from Pfizer Belgium. Dr. Shaaban was supported by funding from Universiti Sains Malaysia. The primary study by Rooney et al. was funded by the United Kingdom National Health Service Lothian Neuro-Oncology Endowment Fund. The primary study by Sidebottom et al. was funded by a grant from the United States Department of Health and Human Services, Health Resources and Services Administration (grant No. R40MC07840). Simning et al.’s research was supported in part by grants from the NIH (T32 GM07356), Agency for Healthcare Research and Quality (R36 HS018246), NIMH (R24 MH071604), and the National Center for Research Resources (TL1 RR024135). Dr. Stafford received PhD scholarship funding from the University of Melbourne. Collection of data for the studies by Turner et al. were funded by a bequest from Jennie Thomas through the Hunter Medical Research Institute. Collection of data for the primary study by Williams et al. was supported by a NIMH grant to Dr. Marsh (RO1-MH069666). The primary study by Thombs et al. was done with data from the Heart and Soul Study (PI Mary Whooley). The Heart and Soul Study was funded by the Department of Veterans Epidemiology Merit Review Program, the Department of Veterans Affairs Health Services Research and Development Service, the National Heart Lung and Blood Institute (R01 HL079235), the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Ischemia Research and Education Foundation. Dr. Thombs was supported by an Investigator Award from the Arthritis Society. The primary study by Twist et al. was funded by the UK National Institute for Health Research under its Programme Grants for Applied Research Programme (grant reference No. RP-PG-0606-1142). The study by Wittkampf et al. was funded by The Netherlands Organization for Health Research and Development (ZonMw) Mental Health Program (No. 100.003.005 and 100.002.021) and the Academic Medical Center/University of Amsterdam. Collection of data for the primary study by Zhang et al. was supported by the European Foundation for Study of Diabetes, the Chinese Diabetes Society, Lilly Foundation, Asia Diabetes Foundation, and Liao Wun Yuk Diabetes Memorial Fund. Drs. Thombs and Benedetti were supported by Fonds de recherche du Québec – Santé (FRQS) researcher salary awards. No other authors reported funding for primary studies or for their work on the present study. Author Contributions C.H., B. Levis, J.B., P.C., S.G., J.P.A.I., L.A.K., D.M., S.B.P., I.S., R.J.S., R.C.Z., B.D.T., and A. Benedetti were responsible for the study conception and design. J.B. and L.A.K. designed and conducted database searches to identify eligible studies. D.H.A., B.A., L.A., H.R.B., M.B., A. Beraldi, C.H.B., H.B., P.B., G.C., M.H.C., J.C.N.C., R.C., K.C., Y.C., J.M.G., J.R.F., F.H.F., D.F., B.G., F.G.S., C.G.G., B.J.H., J.H., P.A.H., M. Härter, U.H., L.H., S.E.H., M. Hudson, T.H., M. Inagaki, K.I., N.J., M.E.K., K.M.K., Y.K., F.L., S.L., M.L., S.R.L., B. Löwe, L.M., A.M., S.M., T.N.M., K.M., F.L.O., V.P., B.W.P., P.P., A.P., K.R., A.G.R., I.S.S., J.S., A. Sidebottom, A. Simning, L.S., S.S., P.L.L.T., A.T., H.C.W., J.W., M.A.W., K.W., K.A.W., M.Y., and B.D.T. were responsible for collection of primary data included in this study. C.H., B. Levis, K.E.R., N.S., A.W.L., M.A., D.B.R., A.K., Y.W., Y.S., M. Imran, and B.D.T. contributed to data extraction and coding for the meta-analysis. C.H., B. Levis, B.D.T., and A.Benedetti contributed to the data analysis and interpretation. C.H., B. Levis, B.D.T., and A. Benedetti contributed to drafting the manuscript. All authors provided a critical review and approved the final paper. B.D.T. and A. Benedetti are the guarantors.

PY - 2020

Y1 - 2020

N2 - Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.

AB - Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.

KW - Depression

KW - Diagnostic accuracy

KW - Meta-analysis

KW - Patient Health Questionnaire-9

KW - Screening

KW - CLINIMETRICS

KW - PERFORMANCE

KW - PREVALENCE

KW - PHQ-9

KW - PRIMARY-CARE

KW - INVENTORY

KW - RECOMMENDATIONS

KW - INTERNATIONAL DIAGNOSTIC INTERVIEW

KW - VALIDITY

KW - SEVERITY

UR - http://www.scopus.com/inward/record.url?scp=85073678831&partnerID=8YFLogxK

U2 - 10.1159/000502294

DO - 10.1159/000502294

M3 - Article

C2 - 31593971

AN - SCOPUS:85073678831

SN - 0033-3190

VL - 89

SP - 25

EP - 37

JO - Psychotherapy and Psychosomatics

JF - Psychotherapy and Psychosomatics

ER -

The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis

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