Importance The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression. The Patient Health Questionnaire-2 (PHQ-2) consists of the first 2 items of the PHQ-9 (which assess the frequency of depressed mood and anhedonia) and can be used as a first step to identify patients for evaluation with the full PHQ-9. Objective To estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression. Data Sources MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018). Study Selection Eligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview. Data Extraction and Synthesis Individual participant data were synthesized with bivariate random-effects meta-analysis to estimate pooled sensitivity and specificity of the PHQ-2 alone among studies using semistructured, fully structured, or Mini International Neuropsychiatric Interview (MINI) diagnostic interviews separately and in combination with the PHQ-9 vs the PHQ-9 alone for studies that used semistructured interviews. The PHQ-2 score ranges from 0 to 6, and the PHQ-9 score ranges from 0 to 27. Results Individual participant data were obtained from 100 of 136 eligible studies (44 318 participants; 4572 with major depression [10%]; mean [SD] age, 49 [17] years; 59% female). Among studies that used semistructured interviews, PHQ-2 sensitivity and specificity (95% CI) were 0.91 (0.88-0.94) and 0.67 (0.64-0.71) for cutoff scores of 2 or greater and 0.72 (0.67-0.77) and 0.85 (0.83-0.87) for cutoff scores of 3 or greater. Sensitivity was significantly greater for semistructured vs fully structured interviews. Specificity was not significantly different across the types of interviews. The area under the receiver operating characteristic curve was 0.88 (0.86-0.89) for semistructured interviews, 0.82 (0.81-0.84) for fully structured interviews, and 0.87 (0.85-0.88) for the MINI. There were no significant subgroup differences. For semistructured interviews, sensitivity for PHQ-2 scores of 2 or greater followed by PHQ-9 scores of 10 or greater (0.82 [0.76-0.86]) was not significantly different than PHQ-9 scores of 10 or greater alone (0.86 [0.80-0.90]); specificity for the combination was significantly but minimally higher (0.87 [0.84-0.89] vs 0.85 [0.82-0.87]). The area under the curve was 0.90 (0.89-0.91). The combination was estimated to reduce the number of participants needing to complete the full PHQ-9 by 57% (56%-58%). Conclusions and Relevance In an individual participant data meta-analysis of studies that compared PHQ scores with major depression diagnoses, the combination of PHQ-2 (with cutoff ≥2) followed by PHQ-9 (with cutoff ≥10) had similar sensitivity but higher specificity compared with PHQ-9 cutoff scores of 10 or greater alone. Further research is needed to understand the clinical and research value of this combined approach to screening.

中文翻译：

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单独使用 PHQ-2 并与 PHQ-9 结合用于筛查以检测重度抑郁症的准确性

重要性 患者健康问卷抑郁模块 (PHQ-9) 是一个包含 9 项的自我管理工具，用于检测抑郁症和评估抑郁症的严重程度。患者健康问卷 2 (PHQ-2) 包含 PHQ-9 的前 2 个项目（评估情绪低落和快感缺乏的频率），可作为第一步使用完整的 PHQ 识别患者进行评估-9. 目的评估单独使用PHQ-2并结合PHQ-9检测重性抑郁症的准确性。数据来源 MEDLINE、MEDLINE In-Process & Other Non-Indexed Citations、PsycINFO 和 Web of Science（2000 年 1 月至 2018 年 5 月）。研究选择符合条件的数据集将 PHQ-2 评分与经过验证的诊断访谈中的重度抑郁症诊断进行了比较。数据提取和综合 个体参与者数据通过双变量随机效应荟萃分析进行综合，以评估单独使用半结构化、全结构化或迷你国际神经精神病学访谈 (MINI) 诊断访谈的研究中单独 PHQ-2 的汇总敏感性和特异性。对于使用半结构化访谈的研究，结合 PHQ-9 与单独使用 PHQ-9。PHQ-2 评分范围为 0 至 6，PHQ-9 评分范围为 0 至 27。 结果 个体参与者数据来自 136 项符合条件的研究中的 100 项（44 318 名参与者；4572 名患有重性抑郁症 [10%]；平均[SD] 年龄，49 [17] 岁；59% 是女性）。在使用半结构化访谈的研究中，PHQ-2 敏感性和特异性 (95% CI) 分别为 0.91 (0.88-0.94) 和 0.67 (0.64-0. 71) 对于 2 或更高的截止分数和 0.72 (0.67-0.77) 和 0.85 (0.83-0.87) 对于 3 或更高的截止分数。半结构化面试与全结构化面试的敏感性明显更高。不同类型的访谈的特异性没有显着差异。接受者操作特征曲线下的面积对于半结构化访谈为 0.88 (0.86-0.89)，对于完全结构化访谈为 0.82 (0.81-0.84)，对于 MINI 为 0.87 (0.85-0.88)。没有显着的亚组差异。对于半结构化访谈，PHQ-2 得分为 2 或更高，然后 PHQ-9 得分为 10 或更高（0.82 [0.76-0.86]）的敏感性与单独的 PHQ-9 得分为 10 或更高（0.86 [0.80 -0.90]); 该组合的特异性显着但略高（0.87 [0.84-0.89] vs 0.85 [0.82-0. 87]）。曲线下面积为 0.90 (0.89-0.91)。据估计，这种组合将使需要完成完整 PHQ-9 的参与者数量减少 57% (56%-58%)。结论和相关性在对 PHQ 评分与重度抑郁症诊断进行比较的研究的个体参与者数据荟萃分析中，PHQ-2（截止值≥2）和 PHQ-9（截止值≥10）的组合具有相似的敏感性但更高与单独的 PHQ-9 截止分数为 10 或更高的特异性相比。需要进一步研究以了解这种联合筛查方法的临床和研究价值。结论和相关性在对 PHQ 评分与重度抑郁症诊断进行比较的研究的个体参与者数据荟萃分析中，PHQ-2（截止值≥2）和 PHQ-9（截止值≥10）的组合具有相似的敏感性但更高与单独的 PHQ-9 截止分数为 10 或更高的特异性相比。需要进一步研究以了解这种联合筛查方法的临床和研究价值。结论和相关性在对 PHQ 评分与重度抑郁症诊断进行比较的研究的个体参与者数据荟萃分析中，PHQ-2（截止值≥2）和 PHQ-9（截止值≥10）的组合具有相似的敏感性但更高与单独的 PHQ-9 截止分数为 10 或更高的特异性相比。需要进一步研究以了解这种联合筛查方法的临床和研究价值。