Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.
Journal: Journal of clinical epidemiology
Volume: 122
Issue:
Year of Publication: 2021
Affiliated Institutions: Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada. Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Hull York Medical School and the Department of Health Sciences, University of York, Heslington, NY, UK. Library, Concordia University, Montréal, Québec, Canada. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Family Medicine, McGill University, Montréal, Québec, Canada. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Faculty of Medicine, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran; Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK. Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Klinik für Psychiatrie, Psychotherapie & Psychosomatik, Lehrkrankenhaus der Technischen Universität München, Munich, Germany. University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia. Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe. Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA. Servei de Psiquiatria, Hospital Germans Trias i Pujol, Badalona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Badalona, Spain. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany. Faculty of Health, University of Technology Sydney, Sydney, Australia. Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Duke Global Health Institute, Duke University, Durham, NC, USA. School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA. Department of Psychology, Faculty of Social Sciences, Global and Community Mental Health Research Group, University of Macau, Macau Special Administrative Region, China; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, London, UK. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran. Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. San Lorenzo Huipulco, Tlalpan, México D. F. Mexico. Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Baylor College of Medicine, Houston and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. Department of Nursing, St. Joseph's College, Standish, ME, USA. Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan. Department of Epidemiology and Psychosocial Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico. Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil. Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy. NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA; American College of Radiology, Philadelphia, PA, USA. Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK. Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK. Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. Allina Health, Minneapolis, MN, USA. Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany. Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, Scotland, UK. School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia. Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands. Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile; Millennium Institute for Depression and Personality Research (MIDAP), Ministry of Economy, Macul, Santiago, Chile; Psychiatry Department, Tufts Medical Center, Tufts University, Boston, MA, USA. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA. Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK. Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada; Department of Psychology, McGill University, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada; Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada. Electronic address: brett.thombs@mcgill.ca.
Abstract summary
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.Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status.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%).PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies.Authors & Co-authors: Levis Brooke B Benedetti Andrea A Ioannidis John P A JPA Sun Ying Y Negeri Zelalem Z He Chen C Wu Yin Y Krishnan Ankur A Bhandari Parash Mani PM Neupane Dipika D Imran Mahrukh M Rice Danielle B DB Riehm Kira E KE Saadat Nazanin N Azar Marleine M Boruff Jill J Cuijpers Pim P Gilbody Simon S Kloda Lorie A LA McMillan Dean D Patten Scott B SB Shrier Ian I Ziegelstein Roy C RC Alamri Sultan H SH Amtmann Dagmar D Ayalon Liat L Baradaran Hamid R HR Beraldi Anna A Bernstein Charles N CN Bhana Arvin A Bombardier Charles H CH Carter Gregory G Chagas Marcos H MH Chibanda Dixon D Clover Kerrie K Conwell Yeates Y Diez-Quevedo Crisanto C Fann Jesse R JR Fischer Felix H FH Gholizadeh Leila L Gibson Lorna J LJ Green Eric P EP Greeno Catherine G CG Hall Brian J BJ Haroz Emily E EE Ismail Khalida K Jetté Nathalie N Khamseh Mohammad E ME Kwan Yunxin Y Lara Maria Asunción MA Liu Shen-Ing SI Loureiro Sonia R SR Löwe Bernd B Marrie Ruth Ann RA Marsh Laura L McGuire Anthony A Muramatsu Kumiko K Navarrete Laura L Osório Flávia L FL Petersen Inge I Picardi Angelo A Pugh Stephanie L SL Quinn Terence J TJ Rooney Alasdair G AG Shinn Eileen H EH Sidebottom Abbey A Spangenberg Lena L Tan Pei Lin Lynnette PLL Taylor-Rowan Martin M Turner Alyna A van Weert Henk C HC Vöhringer Paul A PA Wagner Lynne I LI White Jennifer J Winkley Kirsty K Thombs Brett D BD
Study Outcome
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Citations :Authors : 76
Identifiers
Doi : 10.1016/j.jclinepi.2020.02.002SSN : 1878-5921