Manea Laura, Gilbody Simon, McMillan Dean
Hull York Medical School and Department of Health Sciences, University of York, Heslington, York YO105DD, United Kingdom.
Hull York Medical School and Department of Health Sciences, University of York, Heslington, York YO105DD, United Kingdom.
Gen Hosp Psychiatry. 2015 Jan-Feb;37(1):67-75. doi: 10.1016/j.genhosppsych.2014.09.009. Epub 2014 Sep 23.
The depression module of the Patient Health Questionnaire-9 (PHQ-9) is a widely used depression screening instrument in nonpsychiatric settings. The PHQ-9 can be scored using different methods, including an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and a cut-off based on summed-item scores. The algorithm was the originally proposed scoring method to screen for depression. We summarized the diagnostic test accuracy of the PHQ-9 using the algorithm scoring method across a range of validation studies and compared the diagnostic properties of the PHQ-9 using the algorithm and summed scoring method at the proposed cut-off point of 10.
We performed a systematic review of diagnostic accuracy studies of the PHQ-9 using the algorithm scoring method to detect major depressive disorder (MDD). We used meta-analytic methods to calculate summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for diagnosing MDD of the PHQ-9 using algorithm scoring method. In studies that reported both scoring methods (algorithm and summed-item scoring at proposed cut-off point of ≥10), we compared the diagnostic properties of the PHQ-9 using these methods.
We found 27 validation studies that validated the algorithm scoring method of the PHQ-9 in various settings. There was substantial heterogeneity across studies, which makes the pooled results difficult to interpret. In general, sensitivity was low whereas specificity was good. Thirteen studies reported the diagnostic properties of the PHQ-9 for both scoring methods. Pooled sensitivity for algorithm scoring method was lower while specificities were good for both scoring methods. Heterogeneity was consistently high; therefore, caution should be used when interpreting these results.
This review shows that, if the algorithm scoring method is used, the PHQ-9 has a low sensitivity for detecting MDD. This could be due to the rating scale categories of the measure, higher specificity or other factors that warrant further research. The summed-item score method at proposed cut-off point of ≥10 has better diagnostic performance for screening purposes or where a high sensitivity is needed.
患者健康问卷-9（PHQ-9）的抑郁模块是在非精神科环境中广泛使用的抑郁筛查工具。PHQ-9可以使用不同的方法进行评分，包括基于《精神疾病诊断与统计手册》第四版标准的算法以及基于项目总分的临界值。该算法是最初提出的用于筛查抑郁的评分方法。我们总结了在一系列验证研究中使用该算法评分方法时PHQ-9的诊断测试准确性，并在建议的临界值10处比较了使用该算法和项目总分评分方法时PHQ-9的诊断特性。
我们对使用算法评分方法检测重度抑郁症（MDD）的PHQ-9诊断准确性研究进行了系统评价。我们使用荟萃分析方法计算使用算法评分方法诊断PHQ-9的MDD的汇总敏感性、特异性、似然比和诊断比值比。在报告了两种评分方法（算法和在建议临界值≥10时的项目总分评分）的研究中，我们比较了使用这些方法时PHQ-9的诊断特性。
我们找到了27项验证研究，这些研究在各种环境中验证了PHQ-9的算法评分方法。各研究之间存在显著异质性，这使得汇总结果难以解释。总体而言，敏感性较低而特异性良好。13项研究报告了两种评分方法下PHQ-9的诊断特性。算法评分方法的汇总敏感性较低，而两种评分方法的特异性均良好。异质性一直很高；因此，在解释这些结果时应谨慎。
本综述表明，如果使用算法评分方法，PHQ-9检测MDD的敏感性较低。这可能是由于该测量的评分量表类别、较高的特异性或其他需要进一步研究的因素。在建议临界值≥10时的项目总分评分方法在筛查目的或需要高敏感性的情况下具有更好的诊断性能。
