Lady Davis Institute for Medical Research of the Jewish General Hospital and McGill University, Montréal, Québec, Canada.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
BMJ. 2019 Apr 9;365:l1476. doi: 10.1136/bmj.l1476.
To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression.
Individual participant data meta-analysis.
Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015).
Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model.
Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age..
PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups.
PROSPERO CRD42014010673.
确定患者健康问卷-9（PHQ-9）用于筛查以检测重度抑郁症的准确性。
个体参与者数据荟萃分析。
Medline、Medline 进行中和其他非索引引文、PsycINFO 和 Web of Science（2000 年 1 月至 2015 年 2 月）。
合格研究将 PHQ-9 评分与来自经过验证的诊断访谈的重度抑郁症诊断进行比较。从主要报告中提取了主要研究数据和研究水平数据，并进行了综合。对于 PHQ-9 截断分数 5-15，使用双变量随机效应荟萃分析分别估计使用半结构化诊断访谈、完全结构化访谈和迷你国际神经精神（MINI）诊断访谈的研究中，灵敏度和特异性。灵敏度和特异性在参与者亚组中进行了检查，并分别使用荟萃回归，在单个模型中考虑所有亚组变量。
从 72 项合格研究中获得了 58 项研究的数据（共 17357 名参与者；重度抑郁症病例 2312 名）。在使用半结构化访谈的研究中，截断分数为 10 或更高时，综合灵敏度和特异性最高（29 项研究，6725 名参与者；灵敏度 0.88，95%置信区间 0.83 至 0.92；特异性 0.85，0.82 至 0.88）。在截断分数 5-15 之间，半结构化访谈的灵敏度比完全结构化访谈高 5-22%（MINI 除外；14 项研究，7680 名参与者），比 MINI 高 2-15%（15 项研究，2952 名参与者）。不同诊断访谈的特异性相似。PHQ-9 的敏感性似乎与半结构化诊断访谈相当，但对年轻患者的特异性可能低于老年患者；无论年龄大小，都可以使用截断分数为 10 或更高。
与之前将参考标准结合在一起的常规荟萃分析相比，PHQ-9 与半结构化诊断访谈的敏感性更高。截断分数为 10 或更高可最大限度地提高整体和亚组的综合敏感性和特异性。
PROSPERO CRD42014010673。
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