Objective To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups. Design Systematic review and individual participant data meta-analysis. Data sources Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018. Review methods Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics. Results Data from 44 503 total participants (27 146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older. Conclusions Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at [www.depressionscreening100.com/phq][1]. Study registration PROSPERO CRD42014010673. Requests to access data should be made to the corresponding authors. [1]: http://www.depressionscreening100.com/phq

中文翻译：

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患者健康问卷 9 筛查重度抑郁症的准确性：更新的系统评价和个体参与者数据荟萃分析

目的更新先前的个体参与者数据荟萃分析并确定患者健康问卷 9 (PHQ-9) 的准确性，这是一般实践中最常用的抑郁症筛查工具，用于检测整体和研究或参与者亚组的重度抑郁症. 设计系统审查和个体参与者数据荟萃分析。数据来源 Medline、Medline In-Process 和其他非索引引文通过 Ovid、PsycINFO、Web of Science 搜索到 2018 年 5 月 9 日。 审查方法 符合条件的研究管理 PHQ-9 并使用经过验证的半结构化诊断访谈对当前的重度抑郁症状态进行分类（专为临床医生管理而设计）、完全结构化的访谈（专为非专业人士设计）或迷你国际神经精神病学访谈（MINI；专为非专业管理人员设计的简短采访）。在使用半结构化诊断访谈（例如，用于诊断的结构化临床访谈）的研究中，使用双变量随机效应元分析模型分别在临界值 5-15 处获得汇总 PHQ-9 敏感性和特异性的点和区间估计值。和统计手册）、完全结构化的访谈（例如，综合国际诊断访谈）和 MINI。元回归用于研究 PHQ-9 准确性是否与参考标准类别和参与者特征相关。结果 从 127 项符合条件的研究（42 项额外研究；79% 符合条件的研究；86% 符合条件的参与者）中的 100 项中获得了 44 503 名参与者（更新后新增 27 146 名）的数据。在采用半结构化访谈参考标准的研究中，在 ≥10 的标准截断值下汇总的 PHQ-9 敏感性和特异性（95% 置信区间），使联合敏感性和特异性最大化，分别为 0.85（0.79 至 0.89）和 0.85（ 0.82 至 0.87)，分别。参考标准之间的特异性相似，但半结构化访谈研究的敏感性比完全结构化参考标准高 7-24%（中位数 21%），比 MINI 跨界值高 2-14%（中位数 11%）值。在参考标准和临界值中，男性的特异性高 0-10%（中位数 3%），60 岁或以上人群的特异性高 0-12%（中位数 5%）。结论 研究人员和临床医生可以使用结果来确定结果，例如阳性筛查和假阳性筛查的总数，使用 [www.depressionscreening100.com/phq][1] 上的知识翻译工具在不同临床环境下的不同 PHQ-9 临界值。研究注册 PROSPERO CRD42014010673。应向相应的作者提出访问数据的请求。[1]：http://www.depressionscreening100.com/phq