Abstract
BackgroundMajor depressive disorder (MDD) may be present in 10%–20% of patients in medical settings. Routine depression screening is sometimes recommended to improve depression management. However, studies of the diagnostic accuracy of depression screening tools have typically used data-driven, exploratory methods to select optimal cutoffs. Often, these studies report results from a small range of cutoff points around whatever cutoff score is most accurate in that given study. When published data are combined in meta-analyses, estimates of accuracy for different cutoff points may be based on data from different studies, rather than data from all studies for each possible cutoff point. As a result, traditional meta-analyses may generate exaggerated estimates of accuracy. Individual patient data (IPD) meta-analyses can address this problem by synthesizing data from all studies for each cutoff score to obtain diagnostic accuracy estimates. The nine-item Patient Health Questionnaire-9 (PHQ-9) and the shorter PHQ-2 and PHQ-8 are commonly recommended for depression screening. Thus, the primary objectives of our IPD meta-analyses are to determine the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2 to detect MDD among adults across all potentially relevant cutoff scores. Secondary analyses involve assessing accuracy accounting for patient factors that may influence accuracy (age, sex, medical comorbidity).Methods/designData sources will include MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science. We will include studies that included a Diagnostic and Statistical Manual or International Classification of Diseases diagnosis of MDD based on a validated structured or semi-structured clinical interview administered within 2 weeks of the administration of the PHQ. Two reviewers will independently screen titles and abstracts, perform full article review, and extract study data. Disagreements will be resolved by consensus. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Bivariate random-effects meta-analysis will be conducted for the full range of plausible cutoff values.DiscussionThe proposed IPD meta-analyses will allow us to obtain estimates of the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2.Systematic review registrationPROSPERO CRD42014010673
Highlights
Major depressive disorder (MDD) may be present in 10%–20% of patients in medical settings
Methods/design This systematic review has been funded by the Canadian Institutes for Health Research (Funding Reference Number KRS-134297)
We will extract the necessary items from the Patient Health Questionnaire-9 (PHQ-9) to evaluate the briefer Patient Health Questionnaire (PHQ-2) and Patient Health Questionnaire (PHQ-8)
Summary
Depression is a chronic and disabling condition that is the leading global cause of life years lived with disability and plays a major role in coping and prognosis among patients with medical illness [5,6,7,8]. Most patients with depression do not receive adequate care [10,11]. Screening has been proposed as a solution and is currently implemented in practice in many settings in a patchwork fashion. There is a need for properly designed, well-conducted trials to determine if depression screening would benefit patients and, if so, to provide models for implementation in clinical practice. Major limitations in existing evidence on the accuracy of depression screening tools, present a major barrier to conducting high-quality trials and to potentially including screening as a routine part of clinical practice. The PHQ-9 and briefer versions, the PHQ-2 and PHQ-8, are administered, commonly used depression screening tools.
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