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

Levis, B. and Benedetti, A. and Ioannidis, J.P.A. and Sun, Y. and Negeri, Z. and He, C. and Wu, Y. and Krishnan, A. and Bhandari, P.M. and Neupane, D. and Imran, M. and Rice, D.B. and Riehm, K.E. and Saadat, N. and Azar, M. and Boruff, J. and Cuijpers, P. and Gilbody, S. and Kloda, L.A. and McMillan, D. and Patten, S.B. and Shrier, I. and Ziegelstein, R.C. and Alamri, S.H. and Amtmann, D. and Ayalon, L. and Baradaran, H.R. and Beraldi, A. and Bernstein, C.N. and Bhana, A. and Bombardier, C.H. and Carter, G. and Chagas, M.H. and Chibanda, D. and Clover, K. and Conwell, Y. and Diez-Quevedo, C. and Fann, J.R. and Fischer, F.H. and Gholizadeh, L. and Gibson, L.J. and Green, E.P. and Greeno, C.G. and Hall, B.J. and Haroz, E.E. and Ismail, K. and Jetté, N. and Khamseh, M.E. and Kwan, Y. and Lara, M.A. and Liu, S.-I. and Loureiro, S.R. and Löwe, B. and Marrie, R.A. and Marsh, L. and McGuire, A. and Muramatsu, K. and Navarrete, L. and Osório, F.L. and Petersen, I. and Picardi, A. and Pugh, S.L. and Quinn, T.J. and Rooney, A.G. and Shinn, E.H. and Sidebottom, A. and Spangenberg, L. and Tan, P.L.L. and Taylor-Rowan, M. and Turner, A. and van Weert, H.C. and Vöhringer, P.A. and Wagner, L.I. and White, J. and Winkley, K. and Thombs, B.D. (2020) Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis. Journal of Clinical Epidemiology, 122. 115-128.e1.

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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. © 2020 Elsevier Inc.

Item Type: Article
Additional Information: cited By 2
Uncontrolled Keywords: Article; comparative study; diagnostic accuracy; Diagnostic and Statistical Manual of Mental Disorders; human; major depression; measurement accuracy; meta analysis; Patient Health Questionnaire 9; prediction; prevalence; priority journal; semi structured interview; Structured Clinical Interview for DSM Disorders; systematic review
Subjects: WM Psychiatry
Depositing User: eprints admin
Date Deposited: 15 Sep 2020 05:54
Last Modified: 15 Sep 2020 05:54

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