{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:35:39Z","timestamp":1792056939499,"version":"4.4.0"},"reference-count":44,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T00:00:00Z","timestamp":1554768000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression.<\/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 (January 2000-February 2015).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Inclusion criteria<\/jats:title>\n                    <jats:p>Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data were obtained for 58 of 72 eligible studies (total n=17\u2009357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age..<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>PROSPERO CRD42014010673.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj.l1476","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T13:26:22Z","timestamp":1554816382000},"page":"l1476","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1447,"title":["Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis"],"prefix":"10.1136","author":[{"given":"Brooke","family":"Levis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Benedetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5644-8432","authenticated-orcid":false,"given":"Brett D","family":"Thombs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,9]]},"reference":[{"key":"key20190410000251_ref1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1253"},{"key":"key20190410000251_ref2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111035"},{"key":"key20190410000251_ref3","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"key20190410000251_ref4","doi-asserted-by":"publisher","DOI":"10.3928\/0048-5713-20020901-06"},{"key":"key20190410000251_ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.18.1737"},{"key":"key20190410000251_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2007.06.004"},{"key":"key20190410000251_ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-007-0333-y"},{"key":"key20190410000251_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2015.06.012"},{"key":"key20190410000251_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kww191"},{"key":"key20190410000251_ref10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4825"},{"key":"key20190410000251_ref11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0150067"},{"key":"key20190410000251_ref12","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.54"},{"key":"key20190410000251_ref13","volume-title":"Structured clinical interview for the DSM (SCID).","author":"First","year":"1995"},{"key":"key20190410000251_ref14","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800360017003"},{"key":"key20190410000251_ref15","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291701004184"},{"key":"key20190410000251_ref16","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291799008880"},{"key":"key20190410000251_ref17","volume-title":"Handbook of research methods in abnormal and clinical psychology.","author":"Nosen","year":"2008"},{"key":"key20190410000251_ref18","doi-asserted-by":"publisher","DOI":"10.1177\/070674370505001308"},{"key":"key20190410000251_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(97)83296-8"},{"key":"key20190410000251_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(97)83297-X"},{"key":"key20190410000251_ref21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c221"},{"key":"key20190410000251_ref22","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-3-124"},{"key":"key20190410000251_ref23","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19163"},{"key":"key20190410000251_ref24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.3656"},{"key":"key20190410000251_ref25","volume-title":"PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Explanation and Elaboration (PRESS E&E).","author":"McGowan","year":"2016"},{"key":"key20190410000251_ref26","unstructured":"United Nations. 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