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Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis
Open accessAbstract
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.
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“In a large meta-analysis primarily for studies of diverse health care patients, the PHQ-8 evidenced good sensitivity and specificity for detecting major depressive disorder, with similar psychometric qualities as the PHQ-9 [56].”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [56]
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“Although the PHQ-8 omits an item assessing suicidal ideation and self-harm, meta-analytic work shows this version is practically equivalent to the original PHQ-9 measure [68].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [68]
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Metadata
- Authors
- Wu, Y., Levis, B., Riehm, K. E., Saadat, N., Levis, A. W., Azar, M., Rice, D. B., Boruff, J., Cuijpers, P., Gilbody, S., Ioannidis, J. P. A., Kloda, L. A., McMillan, D., Patten, S. B., Shrier, I., Ziegelstein, R. C., Akena, D. H., Arroll, B., Ayalon, L., Baradaran, H. R., Baron, M., Bombardier, C. H., Butterworth, P., Carter, G., Chagas, M. H., Chan, J. C. N., Cholera, R., Conwell, Y., de Man-van Ginkel, J. M., Fann, J. R., Fischer, F. H., Fung, D., Gelaye, B., Goodyear-Smith, F., Greeno, C. G., Hall, B. J., Harrison, P. A., Härter, M., Hegerl, U., Hides, L., Hobfoll, S. E., Hudson, M., Hyphantis, T., Inagaki, M., Jetté, N., Khamseh, M. E., Kiely, K. M., Kwan, Y., Lamers, F., Liu, S.-I., Lotrakul, M., Loureiro, S. R., Löwe, B., McGuire, A., Mohd-Sidik, S., Munhoz, T. N., Muramatsu, K., Osório, F. L., Patel, V., Pence, B. W., Persoons, P., Picardi, A., Reuter, K., Rooney, A. G., Santos, I. S., Shaaban, J., Sidebottom, A., Simning, A., Stafford, L., Sung, S., Tan, P. L. L., Turner, A., van Weert, H. C., White, J., Whooley, M. A., Winkley, K., Yamada, M., Benedetti, A., & Thombs, B. D.
- Affiliations
- Jewish General Hospital (CA)
- McGill University (CA)
- Amsterdam Public Health (NL)
- University of York (GB)
- Stanford University (US)
- Concordia University (CA)
- University of Calgary (CA)
- Johns Hopkins University (US)
- Makerere University (UG)
- University of Auckland (NZ)
- Bar-Ilan University (IL)
- Iran University of Medical Sciences (IR)
- University of Washington (US)
- Australian National University (AU)
- University of Newcastle Australia (AU)
- Universidade de São Paulo (BR)
- Chinese University of Hong Kong (HK)
- University of North Carolina at Chapel Hill (US)
- University of Rochester Medicine (US)
- Stiftung Charité (DE)
- National University of Singapore (SG)
- Harvard University (US)
- University of Pittsburgh (US)
- University Medical Center Hamburg-Eppendorf (DE)
- Goethe University Frankfurt (DE)
- The University of Queensland (AU)
- University of Ioannina (GR)
- Shimane University (JP)
- UNSW Sydney (AU)
- Tan Tock Seng Hospital (SG)
- Mackay Memorial Hospital (TW)
- Mahidol University (TH)
- Saint Joseph's College of Maine (US)
- Universidade Federal de Pelotas (BR)
- Niigata Seiryo University (JP)
- Universitair Ziekenhuis Leuven (BE)
- Istituto Superiore di Sanità (IT)
- University Medical Center Freiburg (DE)
- Royal Edinburgh Hospital (GB)
- Universiti Sains Malaysia (MY)
- Allina Health (US)
- Royal Women's Hospital (AU)
- Duke-NUS Medical School (SG)
- Deakin University (AU)
- Monash University (AU)
- San Francisco VA Medical Center (US)
- King's College London (GB)
- National Center of Neurology and Psychiatry (JP)
- McGill University Health Centre (CA)
- Corresponding author
- Benedetti, Andrea
- Thombs, Brett D.
- ORCID
- Wu, Yin
- Levis, Brooke
- Riehm, Kira E.
- Rice, Danielle B.
- Boruff, Jill
- Cuijpers, Pim
- Gilbody, Simon
- Ioannidis, John P.A.
- Kloda, Lorie A.
- McMillan, Dean
- Patten, Scott B.
- Shrier, Ian
- Ziegelstein, Roy C.
- Akena, Dickens H.
- Arroll, Bruce
- Ayalon, Liat
- Baradaran, Hamid R.
- Baron, Murray
- Bombardier, Charles H.
- Butterworth, Peter
- Carter, Gregory
- Chagas, Marcos H.
- Chan, Juliana C. N.
- Cholera, Rushina
- Conwell, Yeates
- Fann, Jesse R.
- Fischer, Felix H.
- Fung, Daniel
- Gelaye, Bizu
- Greeno, Catherine G.
- Hall, Brian J.
- Harrison, Patricia A.
- Härter, Martin
- Hegerl, Ulrich
- Hides, Leanne
- Hobfoll, Stevan E.
- Hudson, Marie
- Hyphantis, Thomas
- Inagaki, Masatoshi
- Jetté, Nathalie
- Khamseh, Mohammad E.
- Kiely, Kim M.
- Lamers, Femke
- Lotrakul, Manote
- Löwe, Bernd
- McGuire, Anthony
- Munhoz, Tiago N.
- Osório, Flávia L.
- Patel, Vikram
- Pence, Brian W.
- Persoons, Philippe
- Picardi, Angelo
- Rooney, Alasdair G.
- Santos, Iná S.
- Sidebottom, Abbey
- Simning, Adam
- Stafford, Lesley
- Sung, Sharon
- Tan, Pei Lin Lynnette
- Turner, Alyna
- White, Jennifer
- Whooley, Mary A.
- Winkley, Kirsty
- Yamada, Mitsuhiko
- Benedetti, Andrea
- Thombs, Brett D.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-07-12
- Volume
- 50
- Issue
- 8
- Pages
- 1368-1380
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC6954991
- OpenAlex
- W2957607583
- Cited by
- 423
- References
- 30
- Citations by year
- 2026: 69 · 2025: 102 · 2024: 70 · 2023: 62 · 2022: 62 · 2021: 40 · 2020: 16 · 2019: 1
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-07-12)
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- PubMed Central (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Lirias (KU Leuven) (submittedVersion, public-domain)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- eScholarship@McGill (McGill) (submittedVersion, cc-by-nc-nd)
- Figshare (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- PUCRS Repository (Pontifical Catholic University of Rio Grande do Sul) (submittedVersion, cc-by-nc-sa)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- U.S. Department of Veterans Affairs (R01 HL079235)
- Eli Lilly and Company
- Pfizer
- Ohio Board of Regents
- Ischemia Research and Education Foundation (R01 HL079235)
- Health Services Research and Development
- Alberta Health Services
- University of Washington (H133N060032, H133N060003, H133N060033)
- Johns Hopkins University
- University of Pittsburgh
- Banco Santander
- Neuroscience Research Australia
- Duke-NUS Medical School
- Deutsche Rentenversicherung
- Amsterdam University Medical Centers
- Arthritis Society
- National Institute for Health and Care Research (RP-PG-0606-1142)
- European Commission
- Hunter Medical Research Institute
- National University of Singapore
- Nanyang Technological University
- University of Auckland
- Universität Heidelberg
- University of New South Wales
- ZonMw
- Universiteit van Amsterdam
- Bundesministerium für Bildung und Forschung (01GY1150, 01GD0101)
- Ministero della Salute
- Ministry of Health, Labour and Welfare
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (301321/2016-7)
- Eisai
- Mahidol University
- Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul
- Shimane University
- Tehran University of Medical Sciences and Health Services
- Universiti Putra Malaysia
- Universiti Sains Malaysia
- Universidade de Macau (MYRG2015-00109, MYRG2015-00109-FSS)
- Jewish General Hospital
- National Health Research Institutes
- Mackay Memorial Hospital
- Universidade de São Paulo
- Safe Work Australia
- Chinese Diabetes Society
- H. Lundbeck A/S
- University of Ioannina
- National Institutes of Health (R36 HS018246, 5f30mh096664-03, H133N060033, DK-50456)
- Centers for Disease Control and Prevention (R49CE002093)
- Health Resources and Services Administration
- Agency for Healthcare Research and Quality (T32 GM07356, R24 MH071604, R36HS018246, TL1 RR024135)
- Johns Hopkins Bloomberg School of Public Health
- Canadian Institutes of Health Research (FRN83518, (KRS‐134297), 155468_1, 83518)
- Fonds de Recherche du Québec - Santé
- Medical Research Council (MR/J000914/1)
- Australian Research Council (FT130101444)
- National Health and Medical Research Council (1088313, 1002160)
- Health Research Council of New Zealand
- Programme Grants for Applied Research (RP‐PG‐0606‐1142)
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Universitätsklinikum Hamburg-Eppendorf
- National Institute on Disability and Rehabilitation Research (H133N060032, H133N060003, H133N060033)
- National Heart, Lung, and Blood Institute (R01HL079235)
- National Institute of Mental Health (F30 MH096664, K02MH065919, R49 CE002093, T32 GM07356, R01MH069666, R24 MH-56858, R34MH084673, 5F30MH096664, P30 DK50456, K02-MH65919, R24MH071604, MH65919, R01MH073687, R36 HS018246, R34MH072925)
- National Institute of General Medical Sciences (T32GM007356)
- Fogarty International Center
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK050456)
- National Center for Research Resources (R36 HS018246, DK50456, TL1RR024135, 00109, T32 GM07356)
- National Institute on Minority Health and Health Disparities (T37MD001449)
- Canadian Arthritis Network
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- PHQ-8, PHQ-9, Patient Health Questionnaire, major depressive disorder, diagnostic accuracy, sensitivity and specificity, suicide risk, depression screening, cut-off values
- MeSH terms
- Patient Health Questionnaire, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Interviews as Topic, Male, Mass Screening, Middle Aged, Sensitivity and Specificity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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