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

Brooke Levis, Andrea Benedetti, John P. A. Ioannidis, Ying Sun, Zelalem Negeri, Chen He, Yin Wu, Ankur Krishnan, Parash Mani Bhandari, Dipika Neupane, Mahrukh Imran, Danielle B. Rice, Kira E. Riehm, Nazanin Saadat, Marleine Azar, Jill Boruff, Pim Cuijpers, Simon Gilbody, Lorie A. Kloda, Dean McMillanScott 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, Kerrie Clover, Yeates Conwell, Crisanto Diez-Quevedo, Jesse R. Fann, Felix H. Fischer, Leila Gholizadeh, Lorna J. Gibson, Eric P. Green, Catherine G. Greeno, Brian J. Hall, Emily E. Haroz, Khalida Ismail, Nathalie Jette, Mohammad E. Khamseh, Yunxin Kwan, Maria Asuncion Lara, Shen-Ing Liu, Sonia R. Loureiro, Bernd Loewe, Ruth Ann Marrie, Laura Marsh, Anthony McGuire, Kumiko Muramatsu, Laura Navarrete, Flavia L. Osorio, 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. Voehringer, Lynne Wagner, Jennifer White, Kirsty Winkley, Brett D. Thombs*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)115-128.e1
Number of pages14
JournalJournal of Clinical Epidemiology
Volume122
Early online date24 Feb 2020
DOIs
Publication statusPublished - Jun 2020

Keywords

  • Depression prevalence
  • PHQ-9
  • SCID
  • Individual participant data meta-analysis
  • VALIDATING SCREENING TOOLS
  • PERINATAL DEPRESSION
  • DIAGNOSTIC INTERVIEW
  • ANXIETY DISORDERS
  • MAJOR DEPRESSION
  • MENTAL-DISORDERS
  • OLDER-ADULTS
  • VALIDITY
  • SYMPTOMS

Cite this

Levis, B., Benedetti, A., Ioannidis, J. P. A., Sun, Y., Negeri, Z., He, C., Wu, Y., Krishnan, A., Bhandari, P. M., Neupane, D., Imran, M., Rice, D. B., Riehm, K. E., Saadat, N., Azar, M., Boruff, J., Cuijpers, P., Gilbody, S., Kloda, L. A., ... 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. https://doi.org/10.1016/j.jclinepi.2020.02.002