Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies.
Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies.
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DOI：
10.1192/bjpo.bp.115.001685
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发表时间：
2016-03
期刊：
影响因子：
5.4
通讯作者：
Stubbs B
中科院分区：
文献类型：
--
作者：
Mitchell AJ;Yadegarfar M;Gill J;Stubbs B
患者健康问卷（PHQ）是最常用的措施，以筛选抑郁症在初级保健，但仍然缺乏明确的准确性和最佳的评分方法。通过荟萃分析确定PHQ-9-线性、PHQ-9-算法和PHQ-2问题检测成人重度抑郁症（MDD）的诊断准确性。从成立到2015年6月，我们系统地搜索了主要电子数据库。纳入了报告PHQ-9或PHQ-2问题在初级保健中诊断MDD（根据标准分类系统定义）的准确性的文章。我们进行了荟萃分析，荟萃回归，调节剂和敏感性分析。总体而言，纳入了26篇报告40项个体研究的出版物，代表26902人（中位数502，s.d.= 693.7），包括14760名独特的成年人，其中14.3%患有MDD。纳入文献的方法学质量可接受。PHQ-9-线性和PHQ-2的受试者工作特征曲线下的荟萃分析面积显著高于PHQ-9-算法，这一差异在研究的头对头荟萃分析中得到维持。我们最好的敏感性和特异性估计为81.3%（95% CI 71.6-89.3）和85.3%（95% CI 81.0-89.1），56.8%（95% CI 41.2-71.8）和93.3% PHQ-9-线性、PHQ-9-算法和PHQ-2分别为89.3%（95%CI 81.5-95.1）和75.9%（95%CI 70.1-81.3）。对于病例发现（诊断），没有一种方法是合适的，但对于筛选（排除非病例），所有方法都具有良好的临床实用性，尽管必须仔细选择截止阈值。PHQ可用作初级保健的初始第一步评估，PHQ-2足以达到此目的，具有良好的可接受性。然而，PHQ-2和PHQ-9都不能用于确认临床诊断（病例发现）。没有。© 2016年皇家精神病学院。这是一篇开放获取的文章，根据知识共享非商业性，无衍生品（CC BY-NC-ND）许可证的条款分发。
The Patient Health Questionnaire (PHQ) is the most commonly used measure to screen for depression in primary care but there is still lack of clarity about its accuracy and optimal scoring method. To determine via meta-analysis the diagnostic accuracy of the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 questions to detect major depressive disorder (MDD) among adults. We systematically searched major electronic databases from inception until June 2015. Articles were included that reported the accuracy of PHQ-9 or PHQ-2 questions for diagnosing MDD in primary care defined according to standard classification systems. We carried out a meta-analysis, meta-regression, moderator and sensitivity analysis. Overall, 26 publications reporting on 40 individual studies were included representing 26 902 people (median 502, s.d.=693.7) including 14 760 unique adults of whom 14.3% had MDD. The methodological quality of the included articles was acceptable. The meta-analytic area under the receiver operating characteristic curve of the PHQ-9-linear and the PHQ-2 was significantly higher than the PHQ-9-algorithm, a difference that was maintained in head-to-head meta-analysis of studies. Our best estimates of sensitivity and specificity were 81.3% (95% CI 71.6–89.3) and 85.3% (95% CI 81.0–89.1), 56.8% (95% CI 41.2–71.8) and 93.3% (95% CI 87.5–97.3) and 89.3% (95% CI 81.5–95.1) and 75.9% (95% CI 70.1–81.3) for the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 respectively. For case finding (ruling in a diagnosis), none of the methods were suitable but for screening (ruling out non-cases), all methods were encouraging with good clinical utility, although the cut-off threshold must be carefully chosen. The PHQ can be used as an initial first step assessment in primary care and the PHQ-2 is adequate for this purpose with good acceptability. However, neither the PHQ-2 nor the PHQ-9 can be used to confirm a clinical diagnosis (case finding). None. © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.