PHQ-8 和 PHQ-9 诊断准确性的等效性：系统评价和个体参与者数据荟萃分析。
Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis.
机构信息
Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
Department of Psychiatry, McGill University, Montréal, Québec, Canada.
出版信息
Psychol Med. 2020 Jun;50(8):1368-1380. doi: 10.1017/S0033291719001314. Epub 2019 Jul 12.
BACKGROUND
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
METHODS
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
RESULTS
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
CONCLUSIONS
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
背景
患者健康问卷-9（PHQ-9）的第 9 项询问有关死亡和自残的想法，但不询问自杀意念。尽管它有时用于评估自杀风险，但大多数阳性反应与自杀意念无关。因此，不包含第 9 项的 PHQ-8 在研究中越来越多地被使用。我们评估了 PHQ-8 和 PHQ-9 总分相关性和检测重度抑郁症的诊断准确性是否等效。
方法
我们进行了一项个体患者数据荟萃分析。我们拟合了双变量随机效应模型来评估诊断准确性。
结果
纳入了来自 54 项研究的 16742 名参与者（2097 例重度抑郁症病例）。PHQ-8 和 PHQ-9 评分之间的相关性为 0.996（95%置信区间 0.996 至 0.996）。PHQ-9 的标准截断分数为 10 时，PHQ-8 在使用半结构化诊断访谈参考标准的研究中针对 PHQ-8 具有最大的敏感性+特异性（N=27）。在截断值 10 时，PHQ-8 在这些研究（N=27）中的敏感性降低了 0.02（-0.06 至 0.00），特异性增加了 0.01（0.00 至 0.01），使用其他类型访谈的研究也得到了类似的结果（N=27）。对于所有 54 项主要研究的组合，在所有截断值下，PHQ-8 的敏感性比 PHQ-9 低 0.00 至 0.05（在截断值 10 时为 0.03），特异性在所有截断值下均为 0.01（0.00 至 0.01）。
结论
PHQ-8 和 PHQ-9 总分相似。PHQ-8 的敏感性可能略有降低，但特异性相似。
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