12 Semistructured diagnostic interviews (for example, Structured Clinical Interview for DSM Disorders (SCID) 13) are intended to be used by experienced diagnosticians and require clinical judgment. 8 9 Additional limitations included the inability to assess differences across patient subgroups, as subgroup results were not reported in primary studies the inability to exclude participants already diagnosed as having or being treated for depression, who would not be screened in practice but were included in many primary studies 10 11 and the combining of accuracy estimates without differentiating between reference standards. 8 This suggested possible selective cut-off reporting in some primary studies to maximize accuracy. Incomplete reporting of results from cut-off scores other than 10 in the primary studies that were included, however, resulted in cut-off score ranges in which sensitivity implausibly increased as cut-off scores increased. 8 Pooled sensitivity for the standard cut-off score of 10 was 0.78 (95% confidence interval 0.70 to 0.84), and pooled specificity was 0.87 (0.84 to 0.90). 3 5Ī conventional PHQ-9 meta-analysis from 2015 (36 studies, 21 292 participants) evaluated sensitivity and specificity for cut-off scores 7-15 by combining accuracy results for each cut-off score that were published in included primary studies. 3 4 5 6 7 The standard cut-off score for screening to identify possible major depression is 10 or above, 3 4 5 6 7 which was established in the first study on the PHQ-9 (total n=580, major depression n=41).
The Patient Health Questionnaire-9 (PHQ-9) is a nine item questionnaire designed to screen for depression in primary care and other medical settings. Those with positive screening results can then be evaluated to determine whether they have depression and, if appropriate, should be offered treatment. When screening programs are recommended, clinicians are advised to administer a depression symptom questionnaire and to use a pre-identified cut-off threshold to classify patients as having positive or negative screening results. Screening for depression refers to the use of a depression screening questionnaire to identify patients who may have depression but have not been identified.
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