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

Brooke Levis; Andrea Benedetti; John PA Ioannidis; Ying Sun; Zelalem Negeri; Chen He; Yin Wu; Ankur Krishnan; Parash Mani Bhandari; Dipika Neupane; +66 more... Mahrukh Imran; Danielle B Rice; Kira E Riehm; Nazanin Saadat; Marleine Azar; Jill Boruff; Pim Cuijpers; Simon Gilbody; Lorie A Kloda; Dean McMillan; Scott B Patten; Ian Shrier; Roy C Ziegelstein; Sultan H Alamri; Dagmar Amtmann; Liat Ayalon; Hamid R Baradaran; Anna Beraldi; Charles N Bernstein; Arvin Bhana; Charles H Bombardier; Gregory Carter; Marcos H Chagas; Dixon Chibanda ORCID logo; Kerrie Clover; Yeates Conwell; Crisanto Diez-Quevedo; Jesse R Fann; Felix H Fischer; Leila Gholizadeh; Lorna J Gibson ORCID logo; Eric P Green; Catherine G Greeno; Brian J Hall; Emily E Haroz; Khalida Ismail; Nathalie Jetté; Mohammad E Khamseh; Yunxin Kwan; Maria Asunción Lara; Shen-Ing Liu; Sonia R Loureiro; Bernd Löwe; Ruth Ann Marrie; Laura Marsh; Anthony McGuire; Kumiko Muramatsu; Laura Navarrete; Flávia L Osório; Inge Petersen; Angelo Picardi; Stephanie L Pugh; Terence J Quinn; Alasdair G Rooney; Eileen H Shinn; Abbey Sidebottom; Lena Spangenberg; Pei Lin Lynnette Tan; Martin Taylor-Rowan; Alyna Turner; Henk C van Weert; Paul A Vöhringer; Lynne I Wagner; Jennifer White; Kirsty Winkley; Brett D Thombs; (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. ISSN 0895-4356 DOI: 10.1016/j.jclinepi.2020.02.002
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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.


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