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1. Selective cutoff reporting in studies of the accuracy of the Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale: Comparison of results based on published cutoffs versus all cutoffs using individual participant data meta-analysis

Author

Neupane, D, Levis, B, Bhandari, PM, Thombs, BD, Benedetti, A, Sun, Y, He, C, Wu, Y, Krishnan, A, Negeri, Z, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Sanchez, TA, Chiovitti, MJ, Levis, AW, Boruff, JT, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, Patten, SB, Shrier, I, Ziegelstein, RC, Comeau, L, Mitchell, ND, Tonelli, M, Vigod, SN, Akena, DH, Alvarado, R, Arroll, B, Bakare, MO, Baradaran, HR, Beck, CT, Bombardier, CH, Bunevicius, A, Carter, G, Chagas, MH, Chaudron, LH, Cholera, R, Clover, K, Conwell, Y, Castro e Couto, T, de Man-van Ginkel, JM, Delgadillo, J, Fann, JR, Favez, N, Fung, D, Garcia-Esteve, L, Gelaye, B, Goodyear-Smith, F, Hyphantis, T, Inagaki, M, Ismail, K, Jetté, N, Khalifa, DS, Khamseh, ME, Kohlhoff, J, Kozinszky, Z, Kusminskas, L, Liu, SI, Lotrakul, M, Loureiro, SR, Löwe, B, Sidik, SM, Nakić Radoš, S, Osório, FL, Pawlby, SJ, Pence, BW, Rochat, TJ, Rooney, AG, Sharp, DJ, Stafford, L, Su, KP, Sung, SC, Tadinac, M, Darius Tandon, S, Thiagayson, P, Töreki, A, Torres-Giménez, A, Turner, Alyna, van der Feltz-Cornelis, CM, Vega-Dienstmaier, JM, Vöhringer, PA, White, J, Whooley, MA, Winkley, K, Yamada, M, Neupane, D, Levis, B, Bhandari, PM, Thombs, BD, Benedetti, A, Sun, Y, He, C, Wu, Y, Krishnan, A, Negeri, Z, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Sanchez, TA, Chiovitti, MJ, Levis, AW, Boruff, JT, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, Patten, SB, Shrier, I, Ziegelstein, RC, Comeau, L, Mitchell, ND, Tonelli, M, Vigod, SN, Akena, DH, Alvarado, R, Arroll, B, Bakare, MO, Baradaran, HR, Beck, CT, Bombardier, CH, Bunevicius, A, Carter, G, Chagas, MH, Chaudron, LH, Cholera, R, Clover, K, Conwell, Y, Castro e Couto, T, de Man-van Ginkel, JM, Delgadillo, J, Fann, JR, Favez, N, Fung, D, Garcia-Esteve, L, Gelaye, B, Goodyear-Smith, F, Hyphantis, T, Inagaki, M, Ismail, K, Jetté, N, Khalifa, DS, Khamseh, ME, Kohlhoff, J, Kozinszky, Z, Kusminskas, L, Liu, SI, Lotrakul, M, Loureiro, SR, Löwe, B, Sidik, SM, Nakić Radoš, S, Osório, FL, Pawlby, SJ, Pence, BW, Rochat, TJ, Rooney, AG, Sharp, DJ, Stafford, L, Su, KP, Sung, SC, Tadinac, M, Darius Tandon, S, Thiagayson, P, Töreki, A, Torres-Giménez, A, Turner, Alyna, van der Feltz-Cornelis, CM, Vega-Dienstmaier, JM, Vöhringer, PA, White, J, Whooley, MA, Winkley, K, and Yamada, M

Abstract

Objectives: Selectively reported results from only well-performing cutoffs in diagnostic accuracy studies may bias estimates in meta-analyses. We investigated cutoff reporting patterns for the Patient Health Questionnaire-9 (PHQ-9; standard cutoff 10) and Edinburgh Postnatal Depression Scale (EPDS; no standard cutoff, commonly used 10–13) and compared accuracy estimates based on published cutoffs versus all cutoffs. Methods: We conducted bivariate random effects meta-analyses using individual participant data to compare accuracy from published versus all cutoffs. Results: For the PHQ-9 (30 studies, N = 11,773), published results underestimated sensitivity for cutoffs below 10 (median difference: −0.06) and overestimated for cutoffs above 10 (median difference: 0.07). EPDS (19 studies, N = 3637) sensitivity estimates from published results were similar for cutoffs below 10 (median difference: 0.00) but higher for cutoffs above 13 (median difference: 0.14). Specificity estimates from published and all cutoffs were similar for both tools. The mean cutoff of all reported cutoffs in PHQ-9 studies with optimal cutoff below 10 was 8.8 compared to 11.8 for those with optimal cutoffs above 10. Mean for EPDS studies with optimal cutoffs below 10 was 9.9 compared to 11.8 for those with optimal cutoffs greater than 10. Conclusion: Selective cutoff reporting was more pronounced for the PHQ-9 than EPDS.

Published
2021

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

Author

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, CH, Butterworth, P, Carter, G, Chagas, MH, Chan, JCN, Cholera, R, 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, T, Inagaki, MD, Jetté, N, Khamseh, ME, Kiely, KM, Kwan, Y, Lamers, F, Liu, S-I, Lotrakul, M, Loureiro, SR, Löwe, B, McGuire, A, Mohd-Sidik, S, Munhoz, TN, Muramatsu, K, Osório, FL, Patel, V, Pence, BW, Persoons, P, Picardi, A, Reuter, K, Rooney, AG, Santos, IS, Shaaban, J, Sidebottom, A, Simning, A, Stafford, MD, Sung, S, Tan, PLL, Turner, A, van Weert, HC, White, J, Whooley, MA, Winkley, K, Yamada, M, Benedetti, A, Thombs, BD, 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, CH, Butterworth, P, Carter, G, Chagas, MH, Chan, JCN, Cholera, R, 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, T, Inagaki, MD, Jetté, N, Khamseh, ME, Kiely, KM, Kwan, Y, Lamers, F, Liu, S-I, Lotrakul, M, Loureiro, SR, Löwe, B, McGuire, A, Mohd-Sidik, S, Munhoz, TN, Muramatsu, K, Osório, FL, Patel, V, Pence, BW, Persoons, P, Picardi, A, Reuter, K, Rooney, AG, Santos, IS, Shaaban, J, Sidebottom, A, Simning, A, Stafford, MD, Sung, S, Tan, PLL, Turner, A, van Weert, HC, White, J, Whooley, MA, Winkley, K, Yamada, M, Benedetti, A, and Thombs, BD

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.

Published
2020

3. Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.

Author

Levis, B, Benedetti, A, Ioannidis, JPA, Sun, Y, Negeri, Z, He, C, Wu, Y, Krishnan, A, Bhandari, PM, Neupane, D, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Boruff, J, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Ziegelstein, RC, Alamri, SH, Amtmann, D, Ayalon, L, Baradaran, HR, Beraldi, A, Bernstein, CN, Bhana, A, Bombardier, CH, Carter, G, Chagas, MH, Chibanda, D, Clover, K, Conwell, Y, Diez-Quevedo, C, Fann, JR, Fischer, FH, Gholizadeh, L, Gibson, LJ, Green, EP, Greeno, CG, Hall, BJ, Haroz, EE, Ismail, K, Jetté, N, Khamseh, ME, Kwan, Y, Lara, MA, Liu, S-I, Loureiro, SR, Löwe, B, Marrie, RA, Marsh, L, McGuire, A, Muramatsu, K, Navarrete, L, Osório, FL, Petersen, I, Picardi, A, Pugh, SL, Quinn, TJ, Rooney, AG, Shinn, EH, Sidebottom, A, Spangenberg, L, Tan, PLL, Taylor-Rowan, M, Turner, A, van Weert, HC, Vöhringer, PA, Wagner, LI, White, J, Winkley, K, Thombs, BD, Levis, B, Benedetti, A, Ioannidis, JPA, Sun, Y, Negeri, Z, He, C, Wu, Y, Krishnan, A, Bhandari, PM, Neupane, D, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Boruff, J, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Ziegelstein, RC, Alamri, SH, Amtmann, D, Ayalon, L, Baradaran, HR, Beraldi, A, Bernstein, CN, Bhana, A, Bombardier, CH, Carter, G, Chagas, MH, Chibanda, D, Clover, K, Conwell, Y, Diez-Quevedo, C, Fann, JR, Fischer, FH, Gholizadeh, L, Gibson, LJ, Green, EP, Greeno, CG, Hall, BJ, Haroz, EE, Ismail, K, Jetté, N, Khamseh, ME, Kwan, Y, Lara, MA, Liu, S-I, Loureiro, SR, Löwe, B, Marrie, RA, Marsh, L, McGuire, A, Muramatsu, K, Navarrete, L, Osório, FL, Petersen, I, Picardi, A, Pugh, SL, Quinn, TJ, Rooney, AG, Shinn, EH, Sidebottom, A, Spangenberg, L, Tan, PLL, Taylor-Rowan, M, Turner, A, van Weert, HC, Vöhringer, PA, Wagner, LI, White, J, Winkley, K, and Thombs, BD

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.

Published
2020

4. Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.

Author

Levis, B, Benedetti, A, Ioannidis, JPA, Sun, Y, Negeri, Z, He, C, Wu, Y, Krishnan, A, Bhandari, PM, Neupane, D, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Boruff, J, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Ziegelstein, RC, Alamri, SH, Amtmann, D, Ayalon, L, Baradaran, HR, Beraldi, A, Bernstein, CN, Bhana, A, Bombardier, CH, Carter, G, Chagas, MH, Chibanda, D, Clover, K, Conwell, Y, Diez-Quevedo, C, Fann, JR, Fischer, FH, Gholizadeh, L, Gibson, LJ, Green, EP, Greeno, CG, Hall, BJ, Haroz, EE, Ismail, K, Jetté, N, Khamseh, ME, Kwan, Y, Lara, MA, Liu, S-I, Loureiro, SR, Löwe, B, Marrie, RA, Marsh, L, McGuire, A, Muramatsu, K, Navarrete, L, Osório, FL, Petersen, I, Picardi, A, Pugh, SL, Quinn, TJ, Rooney, AG, Shinn, EH, Sidebottom, A, Spangenberg, L, Tan, PLL, Taylor-Rowan, M, Turner, A, van Weert, HC, Vöhringer, PA, Wagner, LI, White, J, Winkley, K, Thombs, BD, Levis, B, Benedetti, A, Ioannidis, JPA, Sun, Y, Negeri, Z, He, C, Wu, Y, Krishnan, A, Bhandari, PM, Neupane, D, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Boruff, J, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Ziegelstein, RC, Alamri, SH, Amtmann, D, Ayalon, L, Baradaran, HR, Beraldi, A, Bernstein, CN, Bhana, A, Bombardier, CH, Carter, G, Chagas, MH, Chibanda, D, Clover, K, Conwell, Y, Diez-Quevedo, C, Fann, JR, Fischer, FH, Gholizadeh, L, Gibson, LJ, Green, EP, Greeno, CG, Hall, BJ, Haroz, EE, Ismail, K, Jetté, N, Khamseh, ME, Kwan, Y, Lara, MA, Liu, S-I, Loureiro, SR, Löwe, B, Marrie, RA, Marsh, L, McGuire, A, Muramatsu, K, Navarrete, L, Osório, FL, Petersen, I, Picardi, A, Pugh, SL, Quinn, TJ, Rooney, AG, Shinn, EH, Sidebottom, A, Spangenberg, L, Tan, PLL, Taylor-Rowan, M, Turner, A, van Weert, HC, Vöhringer, PA, Wagner, LI, White, J, Winkley, K, and Thombs, BD

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.

Published
2020

5. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis.

Author

Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Brehaut E, Negeri Z, Fischer FH, Benedetti A, Thombs BD, Depression Screening Data (DEPRESSD) PHQ Collaboration, Che L, Levis A, Riehm K, Saadat N, Azar M, Rice D, Boruff J, Kloda L, Cuijpers P, Gilbody S, Ioannidis J, McMillan D, Patten S, Shrier I, Ziegelstein R, Moore A, Akena D, Amtmann D, Arroll B, Ayalon L, Baradaran H, Beraldi A, Bernstein C, Bhana A, Bombardier C, Buji RI, Butterworth P, Carter G, Chagas M, Chan J, Chan LF, Chibanda D, Cholera R, Clover K, Conway A, Conwell Y, Daray F, de Man-van Ginkel J, Delgadillo J, Diez-Quevedo C, Fann J, Field S, Fisher J, Fung D, Garman E, Gelaye B, Gholizadeh L, Gibson L, Goodyear-Smith F, Green E, Greeno C, Hall B, Hampel P, Hantsoo L, Haroz E, Harter M, Hegerl U, Hides L, Hobfoll S, Honikman S, Hudson M, Hyphantis T, Inagaki M, Ismail K, Jeon HJ, Jetté N, Khamseh M, Kiely K, Kohler S, Kohrt B, Kwan Y, Lamers F, Asunción Lara M, Levin-Aspenson H, Lino V, Liu S-I, Lotrakul M, Loureiro S, Löwe B, Luitel N, Lund C, Marrie RA, Marsh L, Marx B, McGuire A, Mohd Sidik S, Munhoz T, Muramatsu K, Nakku J, Navarrete L, Osório F, Patel V, Pence B, Persoons P, Petersen I, Picardi A, Pugh S, Quinn T, Rancans E, Rathod S, Reuter K, Roch S, Rooney A, Rowe H, Santos I, Schram M, Shaaban J, Shinn E, Sidebottom A, Simning A, Spangenberg L, Stafford L, Sung S, Suzuki K, Swartz R, Tan PLL, Taylor-Rowan M, Tran T, Turner A, van der Feltz-Cornelis C, van Heyningen T, van Weert H, Wagner L, Li Wang J, White J, Winkley K, Wynter K, Yamada M, Zhi Zeng Q, Zhang Y, Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Brehaut E, Negeri Z, Fischer FH, Benedetti A, Thombs BD, Depression Screening Data (DEPRESSD) PHQ Collaboration, Che L, Levis A, Riehm K, Saadat N, Azar M, Rice D, Boruff J, Kloda L, Cuijpers P, Gilbody S, Ioannidis J, McMillan D, Patten S, Shrier I, Ziegelstein R, Moore A, Akena D, Amtmann D, Arroll B, Ayalon L, Baradaran H, Beraldi A, Bernstein C, Bhana A, Bombardier C, Buji RI, Butterworth P, Carter G, Chagas M, Chan J, Chan LF, Chibanda D, Cholera R, Clover K, Conway A, Conwell Y, Daray F, de Man-van Ginkel J, Delgadillo J, Diez-Quevedo C, Fann J, Field S, Fisher J, Fung D, Garman E, Gelaye B, Gholizadeh L, Gibson L, Goodyear-Smith F, Green E, Greeno C, Hall B, Hampel P, Hantsoo L, Haroz E, Harter M, Hegerl U, Hides L, Hobfoll S, Honikman S, Hudson M, Hyphantis T, Inagaki M, Ismail K, Jeon HJ, Jetté N, Khamseh M, Kiely K, Kohler S, Kohrt B, Kwan Y, Lamers F, Asunción Lara M, Levin-Aspenson H, Lino V, Liu S-I, Lotrakul M, Loureiro S, Löwe B, Luitel N, Lund C, Marrie RA, Marsh L, Marx B, McGuire A, Mohd Sidik S, Munhoz T, Muramatsu K, Nakku J, Navarrete L, Osório F, Patel V, Pence B, Persoons P, Petersen I, Picardi A, Pugh S, Quinn T, Rancans E, Rathod S, Reuter K, Roch S, Rooney A, Rowe H, Santos I, Schram M, Shaaban J, Shinn E, Sidebottom A, Simning A, Spangenberg L, Stafford L, Sung S, Suzuki K, Swartz R, Tan PLL, Taylor-Rowan M, Tran T, Turner A, van der Feltz-Cornelis C, van Heyningen T, van Weert H, Wagner L, Li Wang J, White J, Winkley K, Wynter K, Yamada M, Zhi Zeng Q, and Zhang Y

Abstract

Importance:The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression. The Patient Health Questionnaire-2 (PHQ-2) consists of the first 2 items of the PHQ-9 (which assess the frequency of depressed mood and anhedonia) and can be used as a first step to identify patients for evaluation with the full PHQ-9. Objective:To estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression. Data Sources:MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018). Study Selection:Eligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview. Data Extraction and Synthesis:Individual participant data were synthesized with bivariate random-effects meta-analysis to estimate pooled sensitivity and specificity of the PHQ-2 alone among studies using semistructured, fully structured, or Mini International Neuropsychiatric Interview (MINI) diagnostic interviews separately and in combination with the PHQ-9 vs the PHQ-9 alone for studies that used semistructured interviews. The PHQ-2 score ranges from 0 to 6, and the PHQ-9 score ranges from 0 to 27. Results:Individual participant data were obtained from 100 of 136 eligible studies (44 318 participants; 4572 with major depression [10%]; mean [SD] age, 49 [17] years; 59% female). Among studies that used semistructured interviews, PHQ-2 sensitivity and specificity (95% CI) were 0.91 (0.88-0.94) and 0.67 (0.64-0.71) for cutoff scores of 2 or greater and 0.72 (0.67-0.77) and 0.85 (0.83-0.87) for cutoff scores of 3 or greater. Sensitivity was significantly greater for semistructured vs fully structured interviews. Specificity was not significantly different across the types of interviews. The area under the receiver operating characteristic curve was 0.88 (0.86-0.89) for semistructured interviews, 0.82 (0.81-0.84

Published
2020

6. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis.

Author

Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Brehaut E, Negeri Z, Fischer FH, Benedetti A, Thombs BD, Depression Screening Data (DEPRESSD) PHQ Collaboration, Che L, Levis A, Riehm K, Saadat N, Azar M, Rice D, Boruff J, Kloda L, Cuijpers P, Gilbody S, Ioannidis J, McMillan D, Patten S, Shrier I, Ziegelstein R, Moore A, Akena D, Amtmann D, Arroll B, Ayalon L, Baradaran H, Beraldi A, Bernstein C, Bhana A, Bombardier C, Buji RI, Butterworth P, Carter G, Chagas M, Chan J, Chan LF, Chibanda D, Cholera R, Clover K, Conway A, Conwell Y, Daray F, de Man-van Ginkel J, Delgadillo J, Diez-Quevedo C, Fann J, Field S, Fisher J, Fung D, Garman E, Gelaye B, Gholizadeh L, Gibson L, Goodyear-Smith F, Green E, Greeno C, Hall B, Hampel P, Hantsoo L, Haroz E, Harter M, Hegerl U, Hides L, Hobfoll S, Honikman S, Hudson M, Hyphantis T, Inagaki M, Ismail K, Jeon HJ, Jetté N, Khamseh M, Kiely K, Kohler S, Kohrt B, Kwan Y, Lamers F, Asunción Lara M, Levin-Aspenson H, Lino V, Liu S-I, Lotrakul M, Loureiro S, Löwe B, Luitel N, Lund C, Marrie RA, Marsh L, Marx B, McGuire A, Mohd Sidik S, Munhoz T, Muramatsu K, Nakku J, Navarrete L, Osório F, Patel V, Pence B, Persoons P, Petersen I, Picardi A, Pugh S, Quinn T, Rancans E, Rathod S, Reuter K, Roch S, Rooney A, Rowe H, Santos I, Schram M, Shaaban J, Shinn E, Sidebottom A, Simning A, Spangenberg L, Stafford L, Sung S, Suzuki K, Swartz R, Tan PLL, Taylor-Rowan M, Tran T, Turner A, van der Feltz-Cornelis C, van Heyningen T, van Weert H, Wagner L, Li Wang J, White J, Winkley K, Wynter K, Yamada M, Zhi Zeng Q, Zhang Y, Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Brehaut E, Negeri Z, Fischer FH, Benedetti A, Thombs BD, Depression Screening Data (DEPRESSD) PHQ Collaboration, Che L, Levis A, Riehm K, Saadat N, Azar M, Rice D, Boruff J, Kloda L, Cuijpers P, Gilbody S, Ioannidis J, McMillan D, Patten S, Shrier I, Ziegelstein R, Moore A, Akena D, Amtmann D, Arroll B, Ayalon L, Baradaran H, Beraldi A, Bernstein C, Bhana A, Bombardier C, Buji RI, Butterworth P, Carter G, Chagas M, Chan J, Chan LF, Chibanda D, Cholera R, Clover K, Conway A, Conwell Y, Daray F, de Man-van Ginkel J, Delgadillo J, Diez-Quevedo C, Fann J, Field S, Fisher J, Fung D, Garman E, Gelaye B, Gholizadeh L, Gibson L, Goodyear-Smith F, Green E, Greeno C, Hall B, Hampel P, Hantsoo L, Haroz E, Harter M, Hegerl U, Hides L, Hobfoll S, Honikman S, Hudson M, Hyphantis T, Inagaki M, Ismail K, Jeon HJ, Jetté N, Khamseh M, Kiely K, Kohler S, Kohrt B, Kwan Y, Lamers F, Asunción Lara M, Levin-Aspenson H, Lino V, Liu S-I, Lotrakul M, Loureiro S, Löwe B, Luitel N, Lund C, Marrie RA, Marsh L, Marx B, McGuire A, Mohd Sidik S, Munhoz T, Muramatsu K, Nakku J, Navarrete L, Osório F, Patel V, Pence B, Persoons P, Petersen I, Picardi A, Pugh S, Quinn T, Rancans E, Rathod S, Reuter K, Roch S, Rooney A, Rowe H, Santos I, Schram M, Shaaban J, Shinn E, Sidebottom A, Simning A, Spangenberg L, Stafford L, Sung S, Suzuki K, Swartz R, Tan PLL, Taylor-Rowan M, Tran T, Turner A, van der Feltz-Cornelis C, van Heyningen T, van Weert H, Wagner L, Li Wang J, White J, Winkley K, Wynter K, Yamada M, Zhi Zeng Q, and Zhang Y

Abstract

Importance:The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression. The Patient Health Questionnaire-2 (PHQ-2) consists of the first 2 items of the PHQ-9 (which assess the frequency of depressed mood and anhedonia) and can be used as a first step to identify patients for evaluation with the full PHQ-9. Objective:To estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression. Data Sources:MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018). Study Selection:Eligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview. Data Extraction and Synthesis:Individual participant data were synthesized with bivariate random-effects meta-analysis to estimate pooled sensitivity and specificity of the PHQ-2 alone among studies using semistructured, fully structured, or Mini International Neuropsychiatric Interview (MINI) diagnostic interviews separately and in combination with the PHQ-9 vs the PHQ-9 alone for studies that used semistructured interviews. The PHQ-2 score ranges from 0 to 6, and the PHQ-9 score ranges from 0 to 27. Results:Individual participant data were obtained from 100 of 136 eligible studies (44 318 participants; 4572 with major depression [10%]; mean [SD] age, 49 [17] years; 59% female). Among studies that used semistructured interviews, PHQ-2 sensitivity and specificity (95% CI) were 0.91 (0.88-0.94) and 0.67 (0.64-0.71) for cutoff scores of 2 or greater and 0.72 (0.67-0.77) and 0.85 (0.83-0.87) for cutoff scores of 3 or greater. Sensitivity was significantly greater for semistructured vs fully structured interviews. Specificity was not significantly different across the types of interviews. The area under the receiver operating characteristic curve was 0.88 (0.86-0.89) for semistructured interviews, 0.82 (0.81-0.84

Published
2020

7. Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.

Author

Levis, B, Benedetti, A, Ioannidis, JPA, Sun, Y, Negeri, Z, He, C, Wu, Y, Krishnan, A, Bhandari, PM, Neupane, D, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Boruff, J, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Ziegelstein, RC, Alamri, SH, Amtmann, D, Ayalon, L, Baradaran, HR, Beraldi, A, Bernstein, CN, Bhana, A, Bombardier, CH, Carter, G, Chagas, MH, Chibanda, D, Clover, K, Conwell, Y, Diez-Quevedo, C, Fann, JR, Fischer, FH, Gholizadeh, L, Gibson, LJ, Green, EP, Greeno, CG, Hall, BJ, Haroz, EE, Ismail, K, Jetté, N, Khamseh, ME, Kwan, Y, Lara, MA, Liu, S-I, Loureiro, SR, Löwe, B, Marrie, RA, Marsh, L, McGuire, A, Muramatsu, K, Navarrete, L, Osório, FL, Petersen, I, Picardi, A, Pugh, SL, Quinn, TJ, Rooney, AG, Shinn, EH, Sidebottom, A, Spangenberg, L, Tan, PLL, Taylor-Rowan, M, Turner, A, van Weert, HC, Vöhringer, PA, Wagner, LI, White, J, Winkley, K, Thombs, BD, Levis, B, Benedetti, A, Ioannidis, JPA, Sun, Y, Negeri, Z, He, C, Wu, Y, Krishnan, A, Bhandari, PM, Neupane, D, Imran, M, Rice, DB, Riehm, KE, Saadat, N, Azar, M, Boruff, J, Cuijpers, P, Gilbody, S, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Ziegelstein, RC, Alamri, SH, Amtmann, D, Ayalon, L, Baradaran, HR, Beraldi, A, Bernstein, CN, Bhana, A, Bombardier, CH, Carter, G, Chagas, MH, Chibanda, D, Clover, K, Conwell, Y, Diez-Quevedo, C, Fann, JR, Fischer, FH, Gholizadeh, L, Gibson, LJ, Green, EP, Greeno, CG, Hall, BJ, Haroz, EE, Ismail, K, Jetté, N, Khamseh, ME, Kwan, Y, Lara, MA, Liu, S-I, Loureiro, SR, Löwe, B, Marrie, RA, Marsh, L, McGuire, A, Muramatsu, K, Navarrete, L, Osório, FL, Petersen, I, Picardi, A, Pugh, SL, Quinn, TJ, Rooney, AG, Shinn, EH, Sidebottom, A, Spangenberg, L, Tan, PLL, Taylor-Rowan, M, Turner, A, van Weert, HC, Vöhringer, PA, Wagner, LI, White, J, Winkley, K, and Thombs, BD

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.

Published
2020

8. Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

Author

Ishihara, M., Harel, D., Levis, B., Levis, A.W., Riehm, K.E., Saadat, N., Azar, M., Rice, D.B., Sanchez, T.A., Chiovitti, M.J., Cuijpers, P., Gilbody, S., Ioannidis, J.P.A., Kloda, L.A., McMillan, D., Patten, S.B., Shrier, I., Arroll, B., Bombardier, C.H., Butterworth, P., Carter, G., Clover, K., Conwell, Y., Goodyear-Smith, F., Greeno, C.G., Hambridge, J., Harrison, P.A., Hudson, M., Jetté, N., Kiely, K.M., McGuire, A., Pence, B.W., Rooney, A.G., Sidebottom, A., Simning, A., Turner, A., White, J., Whooley, M.A., Winkley, K., Benedetti, A., Thombs, B.D., Ishihara, M., Harel, D., Levis, B., Levis, A.W., Riehm, K.E., Saadat, N., Azar, M., Rice, D.B., Sanchez, T.A., Chiovitti, M.J., Cuijpers, P., Gilbody, S., Ioannidis, J.P.A., Kloda, L.A., McMillan, D., Patten, S.B., Shrier, I., Arroll, B., Bombardier, C.H., Butterworth, P., Carter, G., Clover, K., Conwell, Y., Goodyear-Smith, F., Greeno, C.G., Hambridge, J., Harrison, P.A., Hudson, M., Jetté, N., Kiely, K.M., McGuire, A., Pence, B.W., Rooney, A.G., Sidebottom, A., Simning, A., Turner, A., White, J., Whooley, M.A., Winkley, K., Benedetti, A., and Thombs, B.D.

Abstract

Background: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. Methods: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. Results: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). Conclusion: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.

Published
2019
Full Text
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9. Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

Author

Ishihara, M, Harel, D, Levis, B, Levis, AW, Riehm, KE, Saadat, N, Azar, M, Rice, DB, Sanchez, TA, Chiovitti, MJ, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Arroll, B, Bombardier, CH, Butterworth, P, Carter, G, Clover, K, Conwell, Y, Goodyear-Smith, F, Greeno, CG, Hambridge, J, Harrison, PA, Hudson, M, Jetté, N, Kiely, KM, McGuire, A, Pence, BW, Rooney, AG, Sidebottom, A, Simning, A, Turner, A, White, J, Whooley, MA, Winkley, K, Benedetti, A, Thombs, BD, Ishihara, M, Harel, D, Levis, B, Levis, AW, Riehm, KE, Saadat, N, Azar, M, Rice, DB, Sanchez, TA, Chiovitti, MJ, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Arroll, B, Bombardier, CH, Butterworth, P, Carter, G, Clover, K, Conwell, Y, Goodyear-Smith, F, Greeno, CG, Hambridge, J, Harrison, PA, Hudson, M, Jetté, N, Kiely, KM, McGuire, A, Pence, BW, Rooney, AG, Sidebottom, A, Simning, A, Turner, A, White, J, Whooley, MA, Winkley, K, Benedetti, A, and Thombs, BD

Abstract

Background: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. Methods: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. Results: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). Conclusion: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.

Published
2019

10. Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

Author

Ishihara, M., Harel, D., Levis, B., Levis, A.W., Riehm, K.E., Saadat, N., Azar, M., Rice, D.B., Sanchez, T.A., Chiovitti, M.J., Cuijpers, P., Gilbody, S., Ioannidis, J.P.A., Kloda, L.A., McMillan, D., Patten, S.B., Shrier, I., Arroll, B., Bombardier, C.H., Butterworth, P., Carter, G., Clover, K., Conwell, Y., Goodyear-Smith, F., Greeno, C.G., Hambridge, J., Harrison, P.A., Hudson, M., Jetté, N., Kiely, K.M., McGuire, A., Pence, B.W., Rooney, A.G., Sidebottom, A., Simning, A., Turner, A., White, J., Whooley, M.A., Winkley, K., Benedetti, A., Thombs, B.D., Ishihara, M., Harel, D., Levis, B., Levis, A.W., Riehm, K.E., Saadat, N., Azar, M., Rice, D.B., Sanchez, T.A., Chiovitti, M.J., Cuijpers, P., Gilbody, S., Ioannidis, J.P.A., Kloda, L.A., McMillan, D., Patten, S.B., Shrier, I., Arroll, B., Bombardier, C.H., Butterworth, P., Carter, G., Clover, K., Conwell, Y., Goodyear-Smith, F., Greeno, C.G., Hambridge, J., Harrison, P.A., Hudson, M., Jetté, N., Kiely, K.M., McGuire, A., Pence, B.W., Rooney, A.G., Sidebottom, A., Simning, A., Turner, A., White, J., Whooley, M.A., Winkley, K., Benedetti, A., and Thombs, B.D.

Abstract

Background: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. Methods: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. Results: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). Conclusion: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.

Published
2019
Full Text
View/download PDF

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