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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
Wu, Yin1,2,3; Levis, Brooke1,3; Riehm, Kira E.1; Saadat, Nazanin1; Levis, Alexander W.1; Azar, Marleine1; Rice, Danielle B.1,4; Boruff, Jill5; Cuijpers, Pim6; Gilbody, Simon7; Ioannidis, John P.A.8; Kloda, Lorie A.9; McMillan, Dean7; Patten, Scott B.10,11; Shrier, Ian1,3; Ziegelstein, Roy C.12; Akena, Dickens H.13; Arroll, Bruce14; Ayalon, Liat15; Baradaran, Hamid R.16,17; Baron, Murray1,18; Bombardier, Charles H.19; Butterworth, Peter20,21; Carter, Gregory22; Chagas, Marcos H.23; Chan, Juliana C.N.24,25,26; Cholera, Rushina27; Conwell, Yeates28; De Man-Van Ginkel, Janneke M.29; Fann, Jesse R.30; Fischer, Felix H.31; Fung, Daniel32,33,34,35; Gelaye, Bizu36; Goodyear-Smith, Felicity14; Greeno, Catherine G.37; Hall, Brian J.38,39; Harrison, Patricia A.40; Härter, Martin41; Hegerl, Ulrich42; Hides, Leanne43; Hobfoll, Stevan E.44; Hudson, Marie1,18; Hyphantis, Thomas45; Inagaki, Masatoshi46; Jetté, Nathalie10,11,47; Khamseh, Mohammad E.16; Kiely, Kim M.48,49; Kwan, Yunxin50; Lamers, Femke51; Liu, Shen Ing35,52,53,54; Lotrakul, Manote55; Loureiro, Sonia R.23; Löwe, Bernd56; McGuire, Anthony57; Mohd-Sidik, Sherina58; Munhoz, Tiago N.59; Muramatsu, Kumiko60; Osório, Flávia L.23,61; Patel, Vikram62,63; Pence, Brian W.64; Persoons, Philippe65,66; Picardi, Angelo67; Reuter, Katrin68; Rooney, Alasdair G.69; Santos, Iná S.59; Shaaban, Juwita70; Sidebottom, Abbey71; Simning, Adam28; Stafford, Lesley72,73; Sung, Sharon32,35; Tan, Pei Lin Lynnette50; Turner, Alyna74,75; Van Weert, Henk C.76; White, Jennifer77; Whooley, Mary A.78,79,80; Winkley, Kirsty81; Yamada, Mitsuhiko82; Benedetti, Andrea3,18,83; Thombs, Brett D.1,2,3,4,18,84
Source PublicationPsychological Medicine

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.

KeywordDepression Diagnostic Accuracy Individual Participant Data Meta-analysis Meta-analysis Phq-8 Phq-9 Screening Systematic Review
URLView the original
Indexed BySCIE ; SSCI
WOS Research AreaPsychology ; Psychiatry
WOS SubjectPsychology, Clinical ; Psychiatry ; Psychology
WOS IDWOS:000543101300014
Scopus ID2-s2.0-85069052660
Fulltext Access
Citation statistics
Cited Times [WOS]:122   [WOS Record]     [Related Records in WOS]
Document TypeJournal article
CollectionUniversity of Macau
Corresponding AuthorBenedetti, Andrea; Thombs, Brett D.
Affiliation1.Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada
2.Department of Psychiatry, McGill University, Montréal, Canada
3.Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
4.Department of Psychology, McGill University, Montréal, Canada
5.Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Canada
6.Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
7.Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, United Kingdom
8.Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, United States
9.Library, Concordia University, Montréal, Canada
10.Department of Community Health Sciences, University of Calgary, Calgary, Canada
11.Hotchkiss Brain Institute and o'Brien Institute for Public Health, University of Calgary, Calgary, Canada
12.Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, United States
13.Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
14.Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
15.Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
16.Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
17.Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
18.Department of Medicine, McGill University, Montréal, Canada
19.Department of Rehabilitation Medicine, University of Washington, Seattle, United States
20.Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australia
21.Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
22.Centre for Brain and Mental Health Research, University of Newcastle, Australia
23.Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
24.Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
25.Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong, Hong Kong
26.Hong Kong Institute of Diabetes and Obesity, Hong Kong, Hong Kong
27.Department of Pediatrics, University of North Carolina, Chapel Hill School of Medicine, Chapel Hill, United States
28.Department of Psychiatry, University of Rochester Medical Center, New York, United States
29.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
30.Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States
31.Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
32.Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore
33.Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
34.Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
35.Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
36.Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, United States
37.School of Social Work, University of Pittsburgh, Pittsburgh, United States
38.Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macao
39.Department of Health, Behavior and Society Johns Hopkins Bloomberg, School of Public Health, Baltimore, United States
40.City of Minneapolis Health Department, Minneapolis, United States
41.Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
42.Depression Research Center of the German Depression Foundation and Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
43.School of Psychology, University of Queensland, Brisbane, Australia
44.STAR-Stress, Anxiety and Resilience Consultants, Chicago, United States
45.Department of Psychiatry, University of Ioannina, Ioannina, Greece
46.Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
47.Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, United States
48.School of Psychology, University of New South Wales, Sydney, Australia
49.Neuroscience Research Australia, Sydney, Australia
50.Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
51.Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
52.Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
53.Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
54.Department of Medicine, Mackay Medical College, Taipei, Taiwan
55.Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
56.Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
57.Department of Nursing, St. Joseph's College, Standish, United States
58.Department of Psychiatry, Faculty of Medicine and Health Sciences, Cancer Resource and Education Centre, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
59.Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
60.Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
61.National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
62.Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States
63.Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States
64.Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
65.Department of Adult Psychiatry, University Hospitals Leuven, Leuven, Belgium
66.Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
67.Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
68.Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
69.Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, United Kingdom
70.Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
71.Allina Health, Minneapolis, United States
72.Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Melbourne, Australia
73.Melbourne School of Psychological Sciences, University of Melbourne, Australia
74.School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
75.IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
76.Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
77.Monash University, Melbourne, Australia
78.Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States
79.Department of Medicine, Veterans Affairs Medical Center, San Francisco, United States
80.Department of Medicine, University of California San Francisco, San Francisco, United States
81.Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
82.Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi, Kodaira, Tokyo, Japan
83.Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Canada
84.Department of Educational and Counselling Psychology, McGill University, Montréal, Canada
Recommended Citation
GB/T 7714
Wu, Yin,Levis, Brooke,Riehm, Kira E.,et al. Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: A systematic review and individual participant data meta-analysis[J]. Psychological Medicine,2020,50(8):1368-1380.
APA 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.,...&Thombs, Brett D..(2020).Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: A systematic review and individual participant data meta-analysis.Psychological Medicine,50(8),1368-1380.
MLA Wu, Yin,et al."Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: A systematic review and individual participant data meta-analysis".Psychological Medicine 50.8(2020):1368-1380.
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