Highlights
- •We compared Patient Health Questionnaire-9 (PHQ-9) ≥ 10 prevalence with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence in 44 primary studies (9,242 participants and 1,389 SCID major depression cases) that administered the PHQ-9 and SCID.
- •We also examined whether an alternative PHQ-9 cutoff could more accurately estimate prevalence.
- •Pooled PHQ-9 ≥10 prevalence (25%) was double-pooled SCID major depression prevalence (12%); pooled difference from each study was 12%.
- •PHQ-9 ≥14 and PHQ-9 diagnostic algorithm prevalence most closely matched SCID major depression prevalence, but study-level PHQ-9 ≥14 and PHQ-9 diagnostic algorithm prevalence differed from SCID major depression prevalence with 95% prediction intervals of −14% to 15% and −16% to 15%, respectively.
- •Estimates of depression prevalence should be based on validated diagnostic interviews designed for determining case status; users should evaluate published reports of depression prevalence to ensure that they are based on methods intended to classify major depression.
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.
Keywords
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Article info
Publication history
Published online: February 24, 2020
Accepted:
February 18,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
