• 1 Lady Davis Institute for Medical Research, Jewish General Hospital,Montréal,Québec,Canada
  • 2 Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University,Montreal,Quebec,Canada
  • 3 Department of Clinical, Neuro and Developmental Psychology,Amsterdam Public Health Research Institute, Vrije Universiteit,Amsterdam,the Netherlands
  • 4 Hull York Medical School and the Department of Health Sciences,University of York,Heslington, York,UK
  • 5 Department of Medicine,Department of Health Research and Policy,Department of Biomedical Data Science,Department of Statistics,Stanford University, Stanford,California,USA
  • 6 Library, Concordia University,Montréal,Québec,Canada
  • 7 Department of Community Health Sciences,University of Calgary,Calgary, Alberta,Canada
  • 8 Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland,USA
  • 9 Department of Psychiatry,Makerere University College of Health Sciences,Kampala,Uganda
  • 10 Department of General Practice and Primary Health Care,University of Auckland, Auckland,New Zealand
  • 11 Louis and Gabi Weisfeld School of Social Work, Bar Ilan University,Ramat Gan,Israel
  • 12 Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences,Tehran,Iran
  • 13 Department of Rehabilitation Medicine,University of Washington,Seattle,Washington,USA
  • 14 Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University,Canberra,Australia
  • 15 Centre for Brain and Mental Health Research, University of Newcastle,New South Wales,Australia
  • 16 Department of Neurosciences and Behavior,Ribeirão Preto Medical School, University of São Paulo,Ribeirão Preto,Brazil
  • 17 Department of Medicine and Therapeutics,Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR),China
  • 18 Department of Pediatrics,University of North Carolina at Chapel Hill School of Medicine,Chapel Hill,North Carolina,USA
  • 19 Department of Psychiatry,University of Rochester Medical Center,New York,USA
  • 20 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht,the Netherlands
  • 21 Department of Psychiatry and Behavioral Sciences,University of Washington,Seattle, Washington,USA
  • 22 Department of Psychosomatic Medicine,Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin,Germany
  • 23 Department of Child & Adolescent Psychiatry,Institute of Mental Health,Singapore,Singapore
  • 24 Department of Epidemiology,Harvard T. H. Chan School of Public Health,Boston, Massachusetts,USA
  • 25 School of Social Work, University of Pittsburgh,Pittsburgh,Pennsylvania,USA
  • 26 Global and Community Mental Health Research Group,Department of Psychology, Faculty of Social Sciences,University of Macau, Macau Special Administrative Region,China
  • 27 City of Minneapolis Health Department,Minneapolis,Minnesota,USA
  • 28 Department of Medical Psychology,University Medical Center Hamburg-Eppendorf,Hamburg,Germany
  • 29 Depression Research Center of the German Depression Foundation and Department of Psychiatry,Psychosomatics and Psychotherapy, Goethe University, Frankfurt,Germany
  • 30 School of Psychology, University of Queensland,Brisbane,Queensland,Australia
  • 31 STAR-Stress, Anxiety & Resilience Consultants,Chicago,Illinois,USA
  • 32 Department of Psychiatry,University of Ioannina,Ioannina,Greece
  • 33 Department of Psychiatry, Faculty of Medicine,Shimane University,Shimane,Japan
  • 34 School of Psychology, University of New South Wales,Sydney,Australia
  • 35 Department of Psychological Medicine,Tan Tock Seng Hospital,Singapore,Singapore
  • 36 Department of Psychiatry,Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute,Amsterdam,the Netherlands
  • 37 Programme in Health Services & Systems Research, Duke-NUS Medical School,Singapore,Singapore
  • 38 Department of Psychiatry, Faculty of Medicine,Ramathibodi Hospital, Mahidol University,Bangkok,Thailand
  • 39 Department of Psychosomatic Medicine and Psychotherapy,University Medical Center Hamburg-Eppendorf,Hamburg,Germany
  • 40 Department of Nursing,St. Joseph's College,Standish,Maine,USA
  • 41 Department of Psychiatry,Faculty of Medicine and Health Sciences,Cancer Resource & Education Centre, Universiti Putra Malaysia,Serdang,Selangor,Malaysia
  • 42 Post-graduate Program in Epidemiology, Federal University of Pelotas,Pelotas,RS,Brazil
  • 43 Department of Clinical Psychology,Graduate School of Niigata Seiryo University,Niigata,Japan
  • 44 Department of Global Health and Social Medicine,Harvard Medical School,Boston,Massachusetts,USA
  • 45 Department of Epidemiology,Gillings School of Global Public Health, The University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,USA
  • 46 Department of Adult Psychiatry,University Hospitals Leuven,Leuven,Belgium
  • 47 Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health,Rome,Italy
  • 48 Department of Psychiatry and Psychotherapy,University Medical Center Freiburg,Freiburg,Germany
  • 49 Division of Psychiatry,Royal Edinburgh Hospital, University of Edinburg,Edinburgh, Scotland,UK
  • 50 Department of Family Medicine,School of Medical Sciences, Universiti Sains Malaysia,Kelantan,Malaysia
  • 51 Allina Health,Minneapolis,Minnesota,USA
  • 52 Centre for Women's Mental Health, Royal Women's Hospital,Parkville,Melbourne,Australia
  • 53 School of Medicine and Public Health, University of Newcastle,New South Wales,Newcastle,Australia
  • 54 Department of General Practice,Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, location AMC,Amsterdam, the Netherlands
  • 55 Monash University,Melbourne,Australia
  • 56 Department of Epidemiology and Biostatistics,University of California San Francisco,San Francisco,California,USA
  • 57 Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London,London,UK
  • 58 Department of Neuropsychopharmacology,National Institute of Mental Health, National Center of Neurology and Psychiatry,Ogawa-Higashi,Kodaira,Tokyo,Japan
  • 59 Department of Epidemiology, Biostatistics and Occupational Health,McGill University,Montréal,Québec,Canada
Psychol Med, 2019 Jul 12.
PMID: 31298180 DOI: 10.1017/S0033291719001314


BACKGROUND: 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.