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Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis
Abstract
Objective The Patient Health Questionnaire (PHQ-9) is a widely used screening tool for major depressive disorder (MDD), although there is debate surrounding its diagnostic properties. For the PHQ-9, we aimed to: 1. Establish the diagnostic performance at the standard cutoff point (10). 2. Compare the diagnostic performance at the standard cutoff point in different clinical settings. 3. Assess whether there is selective reporting of cutoff points other than 10.Methods We searched three databases - Embase, MEDLINE and PSYCHInfo - and performed a reverse citation search in Web of Science. We selected for inclusion studies of any design that assessed the PHQ-9 in adult populations against recognized gold-standard instruments for the diagnosis of either Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria for major depression. Included studies had to report sufficient information to calculate 2*2 contingency tables. Data extraction and synthesis were performed independently by two researchers. For the included studies, we calculated pooled sensitivity, pooled specificity, positive likelihood, negative likelihood ratio and diagnostic odds ratio for cutoff points 7 to 15.Results Thirty-six studies (21,292 patients) met inclusion criteria. Pooled sensitivity for cutoff point 10 was 0.78 [95% confidence interval (CI), 0.70-0.84], and pooled specificity was 0.87 (95% CI, 0.84-0.90). At this cutoff, the PHQ-9 is a better screener in primary care than secondary care settings. No conclusions could be drawn at cutoff points other than 10 due to selective reporting of data.Conclusions For MDD, the PHQ-9 has acceptable diagnostic properties at cutoff point 10 in different settings. We recommend that future studies report the full range of cutoff points to allow exploration of optimal cutoff points in different settings.
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“It is well-validated and widely used.39”
From Being Mindful: A Long-term Investigation of an Interdisciplinary Course in Mindfulness (2019) · cites this paper as [39]
In the citing paper
“The mild depressive symptoms category is under the cut-off value (10+) consistently proposed to determine the presence of depression using the PHQ-8 and, therefore, could be indicative of subclinical depression or depressive mood (Levis et al., 2019;Moriarty et al., 2015;Salk et al., 2017).”
From Prevalence and age patterns of depression in the United Kingdom. A population-based study (2021) · cites this paper as Moriarty et al., 2015
In the citing paper
“However, the PHQ-8 shows suitable psychometric properties for its use as a screening tool when compared to clinical interviews, showing a very high (but not perfect) sensitivity and specificity to detect major depressive disorders at the general population level (Levis et al., 2019;Moriarty et al., 2015;Wu et al., 2019).”
From Prevalence and age patterns of depression in the United Kingdom. A population-based study (2021) · cites this paper as Moriarty et al., 2015
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Metadata
- Authors
- Moriarty, A. S., Gilbody, S., McMillan, D., & Manea, L.
- Affiliations
- University of York (GB)
- Corresponding author
- Manea, Laura
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 37
- Issue
- 6
- Pages
- 567-576
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W2157786695
- Cited by
- 372
- References
- 53
- Citations by year
- 2026: 20 · 2025: 42 · 2024: 45 · 2023: 58 · 2022: 23 · 2021: 44 · 2020: 51 · 2019: 32 · 2018: 33 · 2017: 12 · 2016: 11
- FWCI
- 2.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (ACF-2014-03-002, CL-2012-03-002)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- PHQ-9, major depressive disorder, depression screening, case finding, diagnostic accuracy, cut-off values, sensitivity and specificity, primary care, secondary care, selective reporting
- MeSH terms
- Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Male, Surveys and Questionnaires, Sensitivity and Specificity
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