Harel, Daphna; Levis, Brooke; Sun, Ying; Fischer, Felix; Ioannidis, John PA; Cuijpers, Pim; Patten, Scott B; Ziegelstein, Roy C; Markham, Sarah; Benedetti, Andrea; +2 more... Thombs, Brett D; DEPRESsion Screening Data DEPRESSD PHQ Collaboration; (2022) External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4. Methods, 204. pp. 300-311. ISSN 1046-2023 DOI: https://doi.org/10.1016/j.ymeth.2021.11.005
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Abstract
Shortened versions of self-reported questionnaires may be used to reduce respondent burden. When shortened screening tools are used, it is desirable to maintain equivalent diagnostic accuracy to full-length forms. This manuscript presents a case study that illustrates how external data and individual participant data meta-analysis can be used to assess the equivalence in diagnostic accuracy between a shortened and full-length form. This case study compares the Patient Health Questionnaire-9 (PHQ-9) and a 4-item shortened version (PHQ-Dep-4) that was previously developed using optimal test assembly methods. Using a large database of 75 primary studies (34,698 participants, 3,392 major depression cases), we evaluated whether the PHQ-Dep-4 cutoff of ≥ 4 maintained equivalent diagnostic accuracy to a PHQ-9 cutoff of ≥ 10. Using this external validation dataset, a PHQ-Dep-4 cutoff of ≥ 4 maximized the sum of sensitivity and specificity, with a sensitivity of 0.88 (95% CI 0.81, 0.93), 0.68 (95% CI 0.56, 0.78), and 0.80 (95% CI 0.73, 0.85) for the semi-structured, fully structured, and MINI reference standard categories, respectively, and a specificity of 0.79 (95% CI 0.74, 0.83), 0.85 (95% CI 0.78, 0.90), and 0.83 (95% CI 0.80, 0.86) for the semi-structured, fully structured, and MINI reference standard categories, respectively. While equivalence with a PHQ-9 cutoff of ≥ 10 was not established, we found the sensitivity of the PHQ-Dep-4 to be non-inferior to that of the PHQ-9, and the specificity of the PHQ-Dep-4 to be marginally smaller than the PHQ-9.
Item Type | Article |
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Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) |
PubMed ID | 34780986 |
Elements ID | 168898 |
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Filename: Harel_etal_2022_External-validation-of-a-shortened.pdf
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Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
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