1. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis
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Leila Gholizadeh, Lai Fong Chan, Alasdair G Rooney, Terence J. Quinn, Pim Cuijpers, Charles H. Bombardier, Brian J. Hall, Iná S. Santos, Eliana Brehaut, Kerrie Clover, Laura Navarrete, Zelalem Negeri, Dagmar Amtmann, Tiago N. Munhoz, Dean McMillan, Stephanie L. Pugh, Nazanin Saadat, Henk van Weert, Thach Duc Tran, Crick Lund, John P. A. Ioannidis, Emily E. Haroz, Catherine G. Greeno, Parash Mani Bhandari, Sally Field, Brandon A. Kohrt, Brett D. Thombs, Juwita Shaaban, Martin Härter, Lynne I. Wagner, Christina M. van der Feltz-Cornelis, Lorna Gibson, Mohammad E. Khamseh, Marcos Hortes Nisihara Chagas, Hong Jin Jeon, Bernd Löwe, Crisanto Diez-Quevedo, Femke Lamers, Dixon Chibanda, Khalida Ismail, Dipika Neupane, Janneke M. de Man-van Ginkel, Sonia Regina Loureiro, Anna Beraldi, Shen-Ing Liu, Lena Spangenberg, Liisa Hantsoo, Lorie A. Kloda, Miranda Schram, Juliana C.N. Chan, Andrea Benedetti, Brian W. Pence, Nathalie Jette, Charles N. Bernstein, Lesley Stafford, Liat Ayalon, Ruth Ann Marrie, Adam Simning, Roy C. Ziegelstein, Hamid Reza Baradaran, Peter Butterworth, Bruce Arroll, Karen Wynter, Yin Wu, Gregory Carter, Valéria Lino, Ulrich Hegerl, Yunxin Kwan, Mahrukh Imran, Qing Zhi Zeng, Sebastian Köhler, Richard Swartz, Vikram Patel, Abbey C. Sidebottom, Petra Hampel, Jennifer White, Marleine Azar, Manote Lotrakul, Ryna Imma Buji, Svenja Roch, Mitsuhiko Yamada, Rushina Cholera, Danielle B. Rice, Bizu Gelaye, Liying Che, Ankur Krishnan, Sherina Mohd Sidik, Emily Garman, Flávia de Lima Osório, Arvin Bhana, Anthony McGuire, Simone Honikman, Kim M. Kiely, Kirsty Winkley, Keiko Suzuki, Maria Asunción Lara, Kumiko Muramatsu, Felix Fischer, Sharon C. Sung, Simon Gilbody, Angelo Picardi, Marie Hudson, Holly Levin-Aspenson, Felicity Goodyear-Smith, Brian Marx, Yeates Conwell, Daniel Fung, Alexander W. Levis, Jesse R. Fann, Pei Lin Lynnette Tan, Jane Fisher, Thomas Hyphantis, Chen He, Eric P. Green, Jaime Delgadillo, Laura Marsh, Eileen H. Shinn, Ying Sun, Brooke Levis, Alyna Turner, Thandi van Heyningen, Ian Shrier, Jill Boruff, Dickens Akena, Yuying Zhang, Katrin Reuter, Stevan E. Hobfoll, Ainsley Moore, Juliet Nakku, Nagendra P. Luitel, Martin Taylor-Rowan, Sujit D Rathod, Scott B. Patten, Kira E. Riehm, Elmars Rancans, Inge Petersen, Heather Rowe, JianLi Wang, Masatoshi Inagaki, Federico M. Daray, Leanne Hides, Aaron Conway, and Philippe Persoons
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Adult ,Male ,medicine.medical_specialty ,Patient Health Questionnaire ,01 natural sciences ,behavioral disciplines and activities ,Sensitivity and Specificity ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,mental disorders ,medicine ,Cutoff ,Humans ,Mass Screening ,030212 general & internal medicine ,0101 mathematics ,Depression (differential diagnoses) ,Mini-international neuropsychiatric interview ,Original Investigation ,Depressive Disorder, Major ,Receiver operating characteristic ,business.industry ,010102 general mathematics ,General Medicine ,medicine.disease ,humanities ,ROC Curve ,Meta-analysis ,Structured interview ,Physical therapy ,Major depressive disorder ,Female ,business - 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) for fully structured interviews, and 0.87 (0.85-0.88) for the MINI. There were no significant subgroup differences. For semistructured interviews, sensitivity for PHQ-2 scores of 2 or greater followed by PHQ-9 scores of 10 or greater (0.82 [0.76-0.86]) was not significantly different than PHQ-9 scores of 10 or greater alone (0.86 [0.80-0.90]); specificity for the combination was significantly but minimally higher (0.87 [0.84-0.89] vs 0.85 [0.82-0.87]). The area under the curve was 0.90 (0.89-0.91). The combination was estimated to reduce the number of participants needing to complete the full PHQ-9 by 57% (56%-58%). Conclusions and relevance In an individual participant data meta-analysis of studies that compared PHQ scores with major depression diagnoses, the combination of PHQ-2 (with cutoff ≥2) followed by PHQ-9 (with cutoff ≥10) had similar sensitivity but higher specificity compared with PHQ-9 cutoff scores of 10 or greater alone. Further research is needed to understand the clinical and research value of this combined approach to screening.
- Published
- 2020
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