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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)
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- 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
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- 2026: 69 · 2025: 102 · 2024: 70 · 2023: 62 · 2022: 62 · 2021: 40 · 2020: 16 · 2019: 1
- FWCI
- 4.39
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- en
- Update notices
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- 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)
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- 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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