The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis
The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis
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DOI：
10.1159/000502294
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发表时间：
2020-01-01
影响因子：
22.8
通讯作者：
Benedetti, Andrea
中科院分区：
文献类型：
--
作者：
He, Chen;Levis, Brooke;Benedetti, Andrea
背景：使用患者健康问卷-9(PHQ-9)筛查重度抑郁症可以使用截断值或PHQ-9诊断算法来完成。许多初步研究只公布了一种方法的结果，以前对算法方法的荟萃分析只包括收集数据并可能公布结果的初步研究的子集。目的：采用个体参与者数据荟萃分析方法，评价两种PHQ-9诊断算法诊断抑郁症的准确性，并与标准PHQ-9截止值>；=10进行比较。方法：Medline、Medline in-Process及其他非索引引文，心理信息网，科学网(2000年1月1日至2015年2月7日)。符合条件的研究使用有效的诊断性访谈对当前的严重抑郁症状态进行分类。结果：在72项确定的合格研究中，54项纳入了数据(n参与者=16,688，n病例=2,091)。在使用半结构化访谈的研究中，原始算法的合并敏感度和特异度(95%可信区间)分别为0.57(0.49，0.64)和0.95(0.94，0.97)，而改进算法的合并敏感度和特异度(95%可信区间)分别为0.61(0.54，0.68)和0.95(0.93，0.96)。与完全结构化访谈相比，算法敏感度降低了0.22-0.24；与迷你国际神经精神病学访谈相比，算法敏感度降低了0.06-0.07。各参比标准的特异度相似。与半结构式访谈相比，PHQ-9中>；=10的临界值的敏感度和特异度(95%可信区间)分别为0.88(0.82-0.92)和0.86(0.82-0.88)。结论：与PHQ-9算法相比，截断值方法似乎是检测重度抑郁症的更好的选择。
Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of >= 10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of >= 10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.