Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.
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.
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%).
PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies.
Levis, B; Benedetti, A; Ioannidis, JPA; Sun, Y; Negeri, Z; He, C; Wu, Y; Krishnan, A; Bhandari, PM; Neupane, D; Imran, M; Rice, DB; Riehm, KE; Saadat, N; Azar, M; Boruff, J; Cuijpers, P; Gilbody, S; Kloda, LA; McMillan, D; Patten, SB; Shrier, I; Ziegelstein, RC; Alamri, SH; Amtmann, D; Ayalon, L; Baradaran, HR; Beraldi, A; Bernstein, CN; Bhana, A; Bombardier, CH; Carter, G; Chagas, MH; Chibanda, D; Clover, K; Conwell, Y; Diez-Quevedo, C; Fann, JR; Fischer, FH; Gholizadeh, L; Gibson, LJ; Green, EP; Greeno, CG; Hall, BJ; Haroz, EE; Ismail, K; Jetté, N; Khamseh, ME; Kwan, Y; Lara, MA; Liu, S-I; Loureiro, SR; Löwe, B; Marrie, RA; Marsh, L; McGuire, A; Muramatsu, K; Navarrete, L; Osório, FL; Petersen, I; Picardi, A; Pugh, SL; Quinn, TJ; Rooney, AG; Shinn, EH; Sidebottom, A; Spangenberg, L; Tan, PLL; Taylor-Rowan, M; Turner, A; van Weert, HC; Vöhringer, PA; Wagner, LI; White, J; Winkley, K; Thombs, BD
Volume / Issue
Start / End Page
Electronic International Standard Serial Number (EISSN)
International Standard Serial Number (ISSN)
Digital Object Identifier (DOI)