Cited by 423Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingMental Health Treatment and Access

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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

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Wu, Yin, Levis, Brooke, Riehm, Kira E., Saadat, Nazanin, Levis, Alexander W., Azar, Marleine, 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, de Man-van Ginkel, Janneke M., Fann, Jesse R., Fischer, Felix H., Fung, Daniel, Gelaye, Bizu, Goodyear-Smith, Felicity, 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., Kwan, Yunxin, Lamers, Femke, Liu, Shen-Ing, Lotrakul, Manote, Loureiro, Sonia R., Löwe, Bernd, McGuire, Anthony, Mohd-Sidik, Sherina, Munhoz, Tiago N., Muramatsu, Kumiko, Osório, Flávia L., Patel, Vikram, Pence, Brian W., Persoons, Philippe, Picardi, Angelo, Reuter, Katrin, Rooney, Alasdair G., Santos, Iná S., Shaaban, Juwita, Sidebottom, Abbey, Simning, Adam, Stafford, Lesley, Sung, Sharon, Tan, Pei Lin Lynnette, Turner, Alyna, van Weert, Henk C., White, Jennifer, Whooley, Mary A., Winkley, Kirsty, Yamada, Mitsuhiko, Benedetti, Andrea, Thombs, Brett D.·2020·Psychological Medicine

DOI 10.1017/s0033291719001314PMC PMC6954991

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Abstract

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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Self-citation
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“Item 9 is sometimes used as an indicator of suicide risk, and it may be useful as a component of modelling approaches for stratifying suicide risk among participants in psychiatric settings (Simon et al., 2013; 2016).”
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2016, PRESS – Peer Review of Electronic Search Strategies: 2015 Guideline Explanation and Elaboration (PRESS EandE)
2013, Diagnostic and Statistical Manual of Mental Disorders

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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
DOI: 10.1017/s0033291719001314
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: other-oa
www.cambridge.org/core/terms (unspecified)
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

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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

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