Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis

By L. Manea, S. Gilbody, D. McMillan. Canadian Medical Association Journal, 2012

1,847 citations recorded by the source corpus.

Background: The brief Patient Health Questionnaire (PHQ-9) is commonly used to screen for depression with 10 often recommended as the cut-off score. We summarized the psychometric properties of the PHQ-9 across a range of studies and cut-off scores to select the optimal cut-off for detecting depression. Methods: We searched Embase, MEDLINE and PsycINFO from 1999 to August 2010 for studies that reported the diagnostic accuracy of PHQ-9 to diagnose major depressive disorders. We calculated summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for detecting major depressive disorder at different cut-off scores and in different settings. We used random-effects bivariate meta-analysis at cutoff points between 7 and 15 to produce summary receiver operating characteristic curves. Results: We identified 18 validation studies (n = 7180) conducted in various clinical settings. Eleven studies provided details about the diagnostic properties of the questionnaire at more than one cut-off score (including 10), four studies reported a cut-off score of 10, and three studies reported cut-off scores other than 10. The pooled specificity results ranged from 0.73 (95% confidence interval [CI] 0.63–0.82) for a cut-off score of 7 to 0.96 (95% CI 0.94–0.97) for a cut-off score of 15. There was major variability in sensitivity for cut-off scores between 7 and 15. There were no substantial differences in the pooled sensitivity and specificity for a range of cut-off scores (8–11). Interpretation: The PHQ-9 was found to have acceptable diagnostic properties for detecting major depressive disorder for cut-off scores between 8 and 11. Authors of future validation studies should consistently report the outcomes for different cut-off scores.

Subfields: Applied Psychology, Pharmacology, Social Psychology

View Paper: https://www.semanticscholar.org/paper/05028e62c2bbcdeef437d5b59461025877c0334e

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Citations in the corpus

A review of depression and suicide risk assessment using speech analysis (2015, methodology): “Both papers use the 9-item Patient Health Questionnaire (PHQ-9) scores associated with their dataset to divide their data into high and low classes: participants who scored above 10, corresponding to moderate depression and above, and participants who scored below 8, corresponding to mild to no depr”
Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students (2020, background): “, 2001) on a 4-point Likert scale from 0 (never) to 3 (nearly every day), with the total score ranging from 0 to 27 and a recommended cutoff score of 10 (Manea et al., 2012).”
A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. (2015, methodology): “We used the same search strategy that we used in a previous systematic review that identified validation studies of the PHQ-9 for various cut-off points [14].”
Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders (2012, background): “Reviews of many PHQ-9 primary care validity studies (Gilbody et al. 2007; Wittkampf et al. 2007; Kroenke et al. 2010; Manea et al. 2012) show a central tendency of the AUC to be 0.”
Depression and Anxiety in Hong Kong during COVID-19 (2020, background): “A total score of ≥10 indicated possible major depression, with s a sensitivity of 80% and specificity of 92% [11,12].”
Perceived social support, received social support, and depression among clergy (2019, methodology): “For categorical descriptions, we report scores (cid:2) 10 to indicate depressive symptoms consistent with moderate-to-severe depression (Manea, Gilbody, & McMillan, 2012).”
Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. (2013, methodology): “A recent meta-analysis also suggests that the cut-off point for screening with the PHQ-9 might need to be adjusted upwards depending upon the population being screened [41].”