A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression
A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression
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DOI：
10.1016/j.genhosppsych.2014.09.009
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发表时间：
2015-01-01
影响因子：
7
通讯作者：
McMillan, Dean
中科院分区：
文献类型：
--
作者：
Manea, Laura;Gilbody, Simon;McMillan, Dean
背景资料：患者健康问卷-9（PHQ-9）的抑郁模块是一种在非精神病环境中广泛使用的抑郁筛查工具。PHQ-9可以使用不同的方法进行评分，包括基于精神障碍诊断和统计手册第四版标准的算法和基于总分的截止值。该算法是最初提出的筛选抑郁症的评分方法。我们总结了一系列验证研究中使用算法评分法的PHQ-9诊断测试准确性，并在建议的临界点10处比较了使用算法评分法和总和评分法的PHQ-9诊断特性。方法：我们对使用算法评分法的PHQ-9诊断准确性研究进行了系统回顾。我们使用Meta分析方法，计算PHQ-9诊断MDD的汇总敏感性、特异性、似然比和诊断优势比，使用算法评分法。在研究中，报告两种评分方法（算法和总和项目评分在建议的截止点>= 10），我们比较了诊断性能的PHQ-9使用这些methods.Results：我们发现27验证研究，验证算法评分方法的PHQ-9在各种设置。研究之间存在大量异质性，这使得汇总结果难以解释。一般来说，敏感性低，而特异性好。13项研究报告了PHQ-9对两种评分方法的诊断特性。算法评分方法的合并敏感性较低，而两种评分方法的特异性良好。杂合性是一贯高，因此，应谨慎使用时，解释这些results.Interpretation：本次审查表明，如果使用的算法评分方法，PHQ-9检测MDD的灵敏度较低。这可能是由于该措施的评级量表类别，更高的特异性或其他因素，值得进一步研究。对于筛查目的或需要高灵敏度的情况，建议临界点>= 10的总和项目评分法具有更好的诊断性能。(C)2015 Elsevier Inc. All rights reserved.
Background: The depression module of the Patient Health Questionnaire-9 (PHQ-9) is a widely used depression screening instrument in nonpsychiatric settings. The PHQ-9 can be scored using different methods, including an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and a cut-off based on summed-item scores. The algorithm was the originally proposed scoring method to screen for depression. We summarized the diagnostic test accuracy of the PHQ-9 using the algorithm scoring method across a range of validation studies and compared the diagnostic properties of the PHQ-9 using the algorithm and summed scoring method at the proposed cut-off point of 10.Methods: We performed a systematic review of diagnostic accuracy studies of the PHQ-9 using the algorithm scoring method to detect major depressive disorder (MDD). We used meta-analytic methods to calculate summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for diagnosing MDD of the PHQ-9 using algorithm scoring method. In studies that reported both scoring methods (algorithm and summed-item scoring at proposed cut-off point of >= 10), we compared the diagnostic properties of the PHQ-9 using these methods.Results: We found 27 validation studies that validated the algorithm scoring method of the PHQ-9 in various settings. There was substantial heterogeneity across studies, which makes the pooled results difficult to interpret. In general, sensitivity was low whereas specificity was good. Thirteen studies reported the diagnostic properties of the PHQ-9 for both scoring methods. Pooled sensitivity for algorithm scoring method was lower while specificities were good for both scoring methods. Heterogeneity was consistently high; therefore, caution should be used when interpreting these results.Interpretation: This review shows that, if the algorithm scoring method is used, the PHQ-9 has a low sensitivity for detecting MDD. This could be due to the rating scale categories of the measure, higher specificity or other factors that warrant further research. The summed-item score method at proposed cut-off point of >= 10 has better diagnostic performance for screening purposes or where a high sensitivity is needed. (C) 2015 Elsevier Inc. All rights reserved.