• Brooke Levis, Ying Sun, Chen He, Yin Wu, Ankur Krishnan, Parash Mani Bhandari, Dipika Neupane, Mahrukh Imran, Eliana Brehaut, Zelalem Negeri, Felix H Fischer, Andrea Benedetti, Brett D Thombs, Depression Screening Data (DEPRESSD) PHQ Collaboration, Liying Che, Alexander Levis, Kira Riehm, Nazanin Saadat, Marleine Azar, Danielle Rice, Jill Boruff, Lorie Kloda, Pim Cuijpers, Simon Gilbody, John Ioannidis, Dean McMillan, Scott Patten, Ian Shrier, Roy Ziegelstein, Ainsley Moore, Dickens Akena, Dagmar Amtmann, Bruce Arroll, Liat Ayalon, Hamid Baradaran, Anna Beraldi, Charles Bernstein, Arvin Bhana, Charles Bombardier, Ryna Imma Buji, Peter Butterworth, Gregory Carter, Marcos Chagas, Juliana Chan, Lai Fong Chan, Dixon Chibanda, Rushina Cholera, Kerrie Clover, Aaron Conway, Yeates Conwell, Federico Daray, Janneke de Man-van Ginkel, Jaime Delgadillo, Crisanto Diez-Quevedo, Jesse Fann, Sally Field, Jane Fisher, Daniel Fung, Emily Garman, Bizu Gelaye, Leila Gholizadeh, Lorna Gibson, Felicity Goodyear-Smith, Eric Green, Catherine Greeno, Brian Hall, Petra Hampel, Liisa Hantsoo, Emily Haroz, Martin Harter, Ulrich Hegerl, Leanne Hides, Stevan Hobfoll, Simone Honikman, Marie Hudson, Thomas Hyphantis, Masatoshi Inagaki, Khalida Ismail, Hong Jin Jeon, Nathalie Jetté, Mohammad Khamseh, Kim Kiely, Sebastian Kohler, Brandon Kohrt, Yunxin Kwan, Femke Lamers, María Asunción Lara, Holly Levin-Aspenson, Valéria Lino, Shen-Ing Liu, Manote Lotrakul, Sonia Loureiro, Bernd Löwe, Nagendra Luitel, Crick Lund, Ruth Ann Marrie, Laura Marsh, Brian Marx, Anthony McGuire, Sherina Mohd Sidik, Tiago Munhoz, Kumiko Muramatsu, Juliet Nakku, Laura Navarrete, Flávia Osório, Vikram Patel, Brian Pence, Philippe Persoons, Inge Petersen, Angelo Picardi, Stephanie Pugh, Terence Quinn, Elmars Rancans, Sujit Rathod, Katrin Reuter, Svenja Roch, Alasdair Rooney, Heather Rowe, Iná Santos, Miranda Schram, Juwita Shaaban, Eileen Shinn, Abbey Sidebottom, Adam Simning, Lena Spangenberg, Lesley Stafford, Sharon Sung, Keiko Suzuki, Richard Swartz, Pei Lin Lynnette Tan, Martin Taylor-Rowan, Thach Tran, Alyna Turner, Christina van der Feltz-Cornelis, Thandi van Heyningen, Henk van Weert, Lynne Wagner, Li Wang Jian J, Jennifer White, Kirsty Winkley, Karen Wynter, Mitsuhiko Yamada, Qing Zhi Zeng, and Yuying Zhang.
• Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
• JAMA. 2020 Jun 9; 323 (22): 2290-2300.

ImportanceThe 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.ObjectiveTo estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression.Data SourcesMEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018).Study SelectionEligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview.Data Extraction And SynthesisIndividual 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.ResultsIndividual 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 RelevanceIn 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.

23 keywords...

hide…