title: The diagnostic accuracy of the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-8 (PHQ-8), and Patient Health Questionnaire-9 (PHQ-9) for detecting major depression: protocol for a systematic review and individual patient data meta-analyses.
abstract: BACKGROUND
  Major 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
  Data 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.
  
  
  CONCLUSIONS
  The proposed IPD meta-analyses will allow us to obtain estimates of the diagnostic accuracy of the PHQ-9, PHQ-8, and PHQ-2.
  
  
  BACKGROUND
  PROSPERO CRD42014010673.
authors.affiliation: Department of Psychiatry, McGill University, Montreal, Quebec, Canada. brett.thombs@mcgill.ca.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Thombs
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.forename: Lorie A
authors.initials: LA
authors.lastname: Kloda
authors.forename: Brooke
authors.initials: B
authors.lastname: Levis
authors.forename: Ioana
authors.initials: I
authors.lastname: Nicolau
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.forename: Ian
authors.initials: I
authors.lastname: Shrier
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Steele
authors.forename: Roy C
authors.initials: RC
authors.lastname: Ziegelstein
mesh_terms: D066264:Datasets as Topic; D003865:Major Depressive Disorder / Q000175:diagnosis*; D006801:Humans; D011237:Predictive Value of Tests; D012107:Research Design; D011795:Surveys and Questionnaires; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic