{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:58:41Z","timestamp":1793642321024,"version":"4.5.1"},"reference-count":69,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2026,6,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the minimal detectable change (MDC) for the Patient Health Questionnaire-9 (PHQ-9) and its eight item (PHQ-8) and two item (PHQ-2) versions including differences by participant and study characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Individual participant data meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline, Medline In-Process and other non-indexed citations, PsycInfo, and Web of Science, 1 January 2000 to 9 May 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria for selecting studies<\/jats:title>\n                    <jats:p>Datasets from articles in any language if participants were aged \u226518 years, were recruited from any non-psychiatric setting, and were not recruited because they were seeking mental healthcare. Eligible datasets had a classification for major depressive disorder or major depressive episode based on a validated semi-structured or fully structured interview conducted within two weeks of administering the PHQ-9, PHQ-8, or PHQ-2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pooled MDCs across studies were estimated for the PHQ-9, PHQ-8, and PHQ-2 with random effects meta-analysis for 95% (MDC95), 90% (MDC90), and 67% (MDC67) confidence that change beyond measurement error occurred. PHQ-9, PHQ-8, and PHQ-2 analyses included 42 548 participants (94 studies), 42 592 participants (94 studies), and 44 085 participants (98 studies), respectively. Mean participant age was 49 years (standard deviation 17), and 60% of participants were women. Overall, 10% of participants had major depression (range 1-57% across studies). MDC95 was 5.72 points (95% confidence interval (CI) 5.54 to 5.90, 95% prediction interval (PI) 4.00 to 7.44) for the PHQ-9, 5.51 points (95% CI 5.33 to 5.68, 95% PI 3.87 to 7.15) for the PHQ-8, and 2.26 points (95% CI 2.15 to 2.37, 95% PI 1.20 to 3.32) for the PHQ-2. For the PHQ-9, MDC95 was highest in inpatient healthcare settings at 6.48 (95% CI 6.05 to 6.92) points. MDC95 for the PHQ-9 increased by 0.40 (95% CI 0.25 to 0.55) points for each 10% increase in the proportion of participants with major depression. Sex and age had minimal or no association. Subgroup and meta-regression findings were similar for the PHQ-8 and PHQ-2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on the pooled estimate, a six point difference on the PHQ-9, the PHQ version most used in clinical practice, could be an appropriate MDC threshold in general practice. A higher threshold may be preferred in specialty mental healthcare. MDC67 or MDC90 thresholds would provide less certainty that change has occurred. Alternative strategies, such as using the upper end of a prediction interval, would provide more certainty but a greater likelihood of not recognising change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study registration<\/jats:title>\n                    <jats:p>\n                      PROSPERO\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT42014010673\">NCT42014010673<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2026-100119","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T02:18:52Z","timestamp":1784859532000},"page":"e100119","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Minimal detectable change of the Patient Health Questionnaire-9, Patient Health Questionnaire-8, and Patient Health Questionnaire-2: individual patient data meta-analysis"],"prefix":"10.1136","volume":"394","clinical-trial-number":[{"clinical-trial-number":"nct42014010673","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct42014010673","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Yutong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montr\u00e9al, QC, Canada"},{"name":"Lady Davis Institute for Medical Research, Jewish General Hospital, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia P","family":"Gonz\u00e1lez-Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Lady Davis Institute for Medical Research, Jewish General Hospital, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill T","family":"Boruff","sequence":"additional","affiliation":[{"name":"McGill University Libraries, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"Levis","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pim","family":"Cuijpers","sequence":"additional","affiliation":[{"name":"Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Gilbody","sequence":"additional","affiliation":[{"name":"Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphna","family":"Harel","sequence":"additional","affiliation":[{"name":"Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P A","family":"Ioannidis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Department of Epidemiology and Population Health, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Markham","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Informatics, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott B","family":"Patten","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone N","family":"Vigod","sequence":"additional","affiliation":[{"name":"Women\u2019s College Hospital and Research Institute, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy C","family":"Ziegelstein","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Benedetti","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montr\u00e9al, QC, Canada"},{"name":"Department of Medicine, McGill University, Montr\u00e9al, QC, Canada"},{"name":"Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5644-8432","authenticated-orcid":true,"given":"Brett D","family":"Thombs","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montr\u00e9al, QC, Canada"},{"name":"Lady Davis Institute for Medical Research, Jewish General Hospital, Montr\u00e9al, QC, Canada"},{"name":"Department of Medicine, McGill University, Montr\u00e9al, QC, Canada"},{"name":"Department of Psychiatry, McGill University, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the DEPRESsion Screening Data (DEPRESSD) PHQ Collaboration","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026072310350960000_394.jul23_8.e100119.1","unstructured":"American Psychological Association. APA Guidelines on Measurement-Based Care. 2025. https:\/\/www.apa.org\/about\/policy\/guidelines-measurement-based-care"},{"key":"2026072310350960000_394.jul23_8.e100119.2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(89)90005-6"},{"key":"2026072310350960000_394.jul23_8.e100119.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.0k375.x"},{"key":"2026072310350960000_394.jul23_8.e100119.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2007.01.008"},{"key":"2026072310350960000_394.jul23_8.e100119.5","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-020-01344-w"},{"key":"2026072310350960000_394.jul23_8.e100119.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.03.012"},{"key":"2026072310350960000_394.jul23_8.e100119.7","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799X-8-40"},{"key":"2026072310350960000_394.jul23_8.e100119.8","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-024-03761-6"},{"key":"2026072310350960000_394.jul23_8.e100119.9","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003853"},{"key":"2026072310350960000_394.jul23_8.e100119.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.04.002"},{"key":"2026072310350960000_394.jul23_8.e100119.11","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291720003700"},{"key":"2026072310350960000_394.jul23_8.e100119.12","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000322"},{"key":"2026072310350960000_394.jul23_8.e100119.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.120226"},{"key":"2026072310350960000_394.jul23_8.e100119.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2004.09.006"},{"key":"2026072310350960000_394.jul23_8.e100119.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2018.11.003"},{"key":"2026072310350960000_394.jul23_8.e100119.16","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2024.1259997"},{"key":"2026072310350960000_394.jul23_8.e100119.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1714"},{"key":"2026072310350960000_394.jul23_8.e100119.18","unstructured":"National Collaborating Centre for Mental Health. The Improving Access to Psychological Therapies Manual. 2018. https:\/\/www.england.nhs.uk\/publication\/the-improving-access-to-psychological-therapies-manual\/"},{"key":"2026072310350960000_394.jul23_8.e100119.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-077220"},{"key":"2026072310350960000_394.jul23_8.e100119.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2013.06.004"},{"key":"2026072310350960000_394.jul23_8.e100119.21","unstructured":"Minist\u00e8re de la Sant\u00e9 et des Services sociaux. Document d\u2019information \u00e0 l\u2019intention des \u00e9tablissements - Programme qu\u00e9b\u00e9cois pour les troubles mentaux : des autosoins \u00e0 la psychoth\u00e9rapie (PQPTM) [Information document for establishments - Quebec program for mental disorders: from self-care to psychotherapy (PQPTM)]. Qu\u00e9bec: Gouvernement du Qu\u00e9bec. 2020. https:\/\/publications.msss.gouv.qc.ca\/msss\/document-002841\/?&type=guide&date=DESC&sujet=pqptm&critere=sujet"},{"key":"2026072310350960000_394.jul23_8.e100119.22","unstructured":"Antony M . The Ontario structured psychotherapy program: evidence-based, publicly funded, stepped-care treatment for depression and anxiety-related Disorders. Richard Swinson Innovations in Anxiety Memorial Lecture. 2023"},{"key":"2026072310350960000_394.jul23_8.e100119.23","unstructured":"Greenspace Health. Reliable change index & caseness threshold. 2025. https:\/\/admin.help.greenspacehealth.com\/article\/647-reliable-change"},{"key":"2026072310350960000_394.jul23_8.e100119.24","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201900295"},{"key":"2026072310350960000_394.jul23_8.e100119.25","unstructured":"National Committee for Quality Assurance. HEDIS depression measures specified for electronic clinical data. https:\/\/www.ncqa.org\/hedis\/the-future-of-hedis\/hedis-depression-measures-specified-for-electronic-clinical-data\/"},{"key":"2026072310350960000_394.jul23_8.e100119.26","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25397"},{"key":"2026072310350960000_394.jul23_8.e100119.27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l1476"},{"key":"2026072310350960000_394.jul23_8.e100119.28","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6504"},{"key":"2026072310350960000_394.jul23_8.e100119.29","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291719001314"},{"key":"2026072310350960000_394.jul23_8.e100119.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2183"},{"key":"2026072310350960000_394.jul23_8.e100119.31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"2026072310350960000_394.jul23_8.e100119.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2024.111443"},{"key":"2026072310350960000_394.jul23_8.e100119.33","unstructured":"Text Recycling Research Project. Best practices for researchers. https:\/\/textrecycling.org\/resources\/best-practices-for-researchers\/"},{"key":"2026072310350960000_394.jul23_8.e100119.34","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-3-124"},{"key":"2026072310350960000_394.jul23_8.e100119.35","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200412000-00006"},{"key":"2026072310350960000_394.jul23_8.e100119.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2016.01.021"},{"key":"2026072310350960000_394.jul23_8.e100119.37","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2026072310350960000_394.jul23_8.e100119.38","doi-asserted-by":"publisher","DOI":"10.1059\/0003-4819-155-8-201110180-00009"},{"key":"2026072310350960000_394.jul23_8.e100119.39","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-4-54"},{"key":"2026072310350960000_394.jul23_8.e100119.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.01.024"},{"key":"2026072310350960000_394.jul23_8.e100119.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.01.032"},{"key":"2026072310350960000_394.jul23_8.e100119.42","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(99)00071-2"},{"key":"2026072310350960000_394.jul23_8.e100119.43","doi-asserted-by":"publisher","DOI":"10.1017\/S1754470X22000484"},{"key":"2026072310350960000_394.jul23_8.e100119.44","doi-asserted-by":"publisher","DOI":"10.1007\/s44192-025-00181-x"},{"key":"2026072310350960000_394.jul23_8.e100119.45","doi-asserted-by":"publisher","DOI":"10.1159\/000543899"},{"key":"2026072310350960000_394.jul23_8.e100119.46","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7894(84)80002-7"},{"key":"2026072310350960000_394.jul23_8.e100119.47","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.59.1.12"},{"key":"2026072310350960000_394.jul23_8.e100119.48","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6148"},{"key":"2026072310350960000_394.jul23_8.e100119.49","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"2026072310350960000_394.jul23_8.e100119.50","unstructured":"R: The R Project for Statistical Computing. https:\/\/www.r-project.org\/"},{"key":"2026072310350960000_394.jul23_8.e100119.51","unstructured":"Posit. Posit. https:\/\/www.posit.co\/"},{"key":"2026072310350960000_394.jul23_8.e100119.52","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v067.i01"},{"key":"2026072310350960000_394.jul23_8.e100119.53","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"2026072310350960000_394.jul23_8.e100119.54","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-073822"},{"key":"2026072310350960000_394.jul23_8.e100119.55","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.03.016"},{"key":"2026072310350960000_394.jul23_8.e100119.56","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d549"},{"key":"2026072310350960000_394.jul23_8.e100119.57","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-023-04804-x"},{"key":"2026072310350960000_394.jul23_8.e100119.58","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2020.02.002"},{"key":"2026072310350960000_394.jul23_8.e100119.59","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-021-02897-z"},{"key":"2026072310350960000_394.jul23_8.e100119.60","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-024-03788-9"},{"key":"2026072310350960000_394.jul23_8.e100119.61","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4022"},{"key":"2026072310350960000_394.jul23_8.e100119.62","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n972"},{"key":"2026072310350960000_394.jul23_8.e100119.63","doi-asserted-by":"publisher","DOI":"10.1177\/0013164411430225"},{"key":"2026072310350960000_394.jul23_8.e100119.64","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-020-04641-1"},{"key":"2026072310350960000_394.jul23_8.e100119.65","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2011.05.007"},{"key":"2026072310350960000_394.jul23_8.e100119.66","doi-asserted-by":"publisher","DOI":"10.5116\/ijme.4dfb.8dfd"},{"key":"2026072310350960000_394.jul23_8.e100119.67","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.0649"},{"key":"2026072310350960000_394.jul23_8.e100119.68","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.06.033"},{"key":"2026072310350960000_394.jul23_8.e100119.69","doi-asserted-by":"publisher","DOI":"10.1177\/0146621616664046"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj-2026-100119","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj-2026-100119","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T02:19:04Z","timestamp":1784859544000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj-2026-100119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":69,"alternative-id":["10.1136\/bmj-2026-100119"],"URL":"https:\/\/doi.org\/10.1136\/bmj-2026-100119","relation":{},"ISSN":["1756-1833"],"issn-type":[{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}