External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4
Issued Date
2022-08-01
Resource Type
ISSN
10462023
eISSN
10959130
Scopus ID
2-s2.0-85120806887
Pubmed ID
34780986
Journal Title
Methods
Volume
204
Start Page
300
End Page
311
Rights Holder(s)
SCOPUS
Bibliographic Citation
Methods Vol.204 (2022) , 300-311
Suggested Citation
Harel D., Levis B., Sun Y., Fischer F., Ioannidis J.P.A., Cuijpers P., Patten S.B., Ziegelstein R.C., Markham S., Benedetti A., Thombs B.D., He C., Wu Y., Krishnan A., Mani Bhandari P., Neupane D., Negeri Z., Imran M., Rice D.B., Riehm K.E., Azar M., Levis A.W., Boruff J., Gilbody S., Kloda L.A., Amtmann D., Ayalon L., Baradaran H.R., Beraldi A., Bernstein C.N., Bhana A., Imma Buji R., Chagas M.H., C. N. Chan J., Fong Chan L., Chibanda D., Conway A., Daray F.M., de Man-van Ginkel J.M., Diez-Quevedo C., Field S., R. W. Fisher J., Fung D., Garman E.C., Flisher A.J., Gelaye B., Gholizadeh L., Gibson L.J., Green E.P., Hall B.J., Hantsoo L., Haroz E.E., Härter M., Hegerl U., Hides L., Hobfoll S.E., Honikman S., Hudson M., Hyphantis T., Inagaki M., Jin Jeon H., Jetté N., Khamseh M.E., Köhler S., Kohrt B.A., Kwan Y., Lamers F., Asunción Lara M., Levin-Aspenson H.F., Liu S.I., Lotrakul M., Loureiro S.R., Löwe B., Luitel N.P., Lund C., Ann Marrie R., Marx B.P., Mohd Sidik S., Munhoz T.N., Muramatsu K., E. M. Nakku J., Navarrete L., Osório F.L., Persoons P., Picardi A., Pugh S.L., Quinn T.J., Rancans E., Rathod S.D., Reuter K., Rowe H.J., Santos I.S., Schram M.T., Shaaban J., Shinn E.H., Spangenberg L., Stafford L., Sung S.C., Suzuki K., Lin Lynnette Tan P. External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4. Methods Vol.204 (2022) , 300-311. 311. doi:10.1016/j.ymeth.2021.11.005 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/83666
Title
External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4
Author(s)
Harel D.
Levis B.
Sun Y.
Fischer F.
Ioannidis J.P.A.
Cuijpers P.
Patten S.B.
Ziegelstein R.C.
Markham S.
Benedetti A.
Thombs B.D.
He C.
Wu Y.
Krishnan A.
Mani Bhandari P.
Neupane D.
Negeri Z.
Imran M.
Rice D.B.
Riehm K.E.
Azar M.
Levis A.W.
Boruff J.
Gilbody S.
Kloda L.A.
Amtmann D.
Ayalon L.
Baradaran H.R.
Beraldi A.
Bernstein C.N.
Bhana A.
Imma Buji R.
Chagas M.H.
C. N. Chan J.
Fong Chan L.
Chibanda D.
Conway A.
Daray F.M.
de Man-van Ginkel J.M.
Diez-Quevedo C.
Field S.
R. W. Fisher J.
Fung D.
Garman E.C.
Flisher A.J.
Gelaye B.
Gholizadeh L.
Gibson L.J.
Green E.P.
Hall B.J.
Hantsoo L.
Haroz E.E.
Härter M.
Hegerl U.
Hides L.
Hobfoll S.E.
Honikman S.
Hudson M.
Hyphantis T.
Inagaki M.
Jin Jeon H.
Jetté N.
Khamseh M.E.
Köhler S.
Kohrt B.A.
Kwan Y.
Lamers F.
Asunción Lara M.
Levin-Aspenson H.F.
Liu S.I.
Lotrakul M.
Loureiro S.R.
Löwe B.
Luitel N.P.
Lund C.
Ann Marrie R.
Marx B.P.
Mohd Sidik S.
Munhoz T.N.
Muramatsu K.
E. M. Nakku J.
Navarrete L.
Osório F.L.
Persoons P.
Picardi A.
Pugh S.L.
Quinn T.J.
Rancans E.
Rathod S.D.
Reuter K.
Rowe H.J.
Santos I.S.
Schram M.T.
Shaaban J.
Shinn E.H.
Spangenberg L.
Stafford L.
Sung S.C.
Suzuki K.
Lin Lynnette Tan P.
Levis B.
Sun Y.
Fischer F.
Ioannidis J.P.A.
Cuijpers P.
Patten S.B.
Ziegelstein R.C.
Markham S.
Benedetti A.
Thombs B.D.
He C.
Wu Y.
Krishnan A.
Mani Bhandari P.
Neupane D.
Negeri Z.
Imran M.
Rice D.B.
Riehm K.E.
Azar M.
Levis A.W.
Boruff J.
Gilbody S.
Kloda L.A.
Amtmann D.
Ayalon L.
Baradaran H.R.
Beraldi A.
Bernstein C.N.
Bhana A.
Imma Buji R.
Chagas M.H.
C. N. Chan J.
Fong Chan L.
Chibanda D.
Conway A.
Daray F.M.
de Man-van Ginkel J.M.
Diez-Quevedo C.
Field S.
R. W. Fisher J.
Fung D.
Garman E.C.
Flisher A.J.
Gelaye B.
Gholizadeh L.
Gibson L.J.
Green E.P.
Hall B.J.
Hantsoo L.
Haroz E.E.
Härter M.
Hegerl U.
Hides L.
Hobfoll S.E.
Honikman S.
Hudson M.
Hyphantis T.
Inagaki M.
Jin Jeon H.
Jetté N.
Khamseh M.E.
Köhler S.
Kohrt B.A.
Kwan Y.
Lamers F.
Asunción Lara M.
Levin-Aspenson H.F.
Liu S.I.
Lotrakul M.
Loureiro S.R.
Löwe B.
Luitel N.P.
Lund C.
Ann Marrie R.
Marx B.P.
Mohd Sidik S.
Munhoz T.N.
Muramatsu K.
E. M. Nakku J.
Navarrete L.
Osório F.L.
Persoons P.
Picardi A.
Pugh S.L.
Quinn T.J.
Rancans E.
Rathod S.D.
Reuter K.
Rowe H.J.
Santos I.S.
Schram M.T.
Shaaban J.
Shinn E.H.
Spangenberg L.
Stafford L.
Sung S.C.
Suzuki K.
Lin Lynnette Tan P.
Author's Affiliation
Faculty of Medicine and Health Sciences
Ramathibodi Hospital
School of Medicine
NYU Shanghai
VA Boston Healthcare System
Duke-NUS Medical School
Niigata Seiryo University
Riga Stradins University
University of Zimbabwe
Concordia University
Stanford University School of Medicine
University Medical Center Utrecht
Royal Women's Hospital, Carlton
Harvard T.H. Chan School of Public Health
London School of Hygiene & Tropical Medicine
The University of Queensland
McGill Faculty of Medicine and Health Sciences
Hospital Universitari Germans Trias i Pujol
Charité – Universitätsmedizin Berlin
The George Washington University School of Medicine and Health Sciences
Iran University of Medical Sciences
Prince of Wales Hospital Hong Kong
University of Technology Sydney
Lady Davis Institute for Medical Research
New York University
University of Notre Dame
College of Health Sciences
Technische Universität München
Monash University
Keele University, School of Medicine
Universiteit Maastricht
University of Toronto
University of York
SKKU School of Medicine
University of Washington
University of Texas MD Anderson Cancer Center
Universidade Federal de Pelotas
Icahn School of Medicine at Mount Sinai
Faculty of Medicine, Nursing and Health Sciences
Stanford University
King's College London
Max Rady College of Medicine, University of Manitoba
Asahikawa Medical University
Stanford Law School
Istituto Superiore Di Sanita
University of Manitoba
Singapore Institute of Mental Health
Shimane University Faculty of Medicine
Duke University
Universidade de São Paulo
Universität Leipzig
Maastricht Universitair Medisch Centrum+
Goethe-Universität Frankfurt am Main
Centre Universitaire de Santé McGill
Johns Hopkins Bloomberg School of Public Health
Universitätsklinikum Hamburg-Eppendorf
University of Ioannina
Bar-Ilan University
School of Medical Sciences, Universiti Sains Malaysia
Université McGill
Universiteit van Amsterdam
Tan Tock Seng Hospital
Universiti Kebangsaan Malaysia
Instituto Nacional de Psiquiatría Ramon de la Fuente
College of Medical, Veterinary & Life Sciences
Universidad de Buenos Aires
Johns Hopkins School of Medicine
Cumming School of Medicine
University of Cape Town
Healthcare Group Sint-Kamillus
Hospital Mesra Bukit Padang
Private Practice for Psychotherapy and Psycho-oncology
STAR-Stress
TPO Nepal
NRG Oncology Statistics and Data Management Center
Butabika National Referral and Teaching Mental Hospital
Ramathibodi Hospital
School of Medicine
NYU Shanghai
VA Boston Healthcare System
Duke-NUS Medical School
Niigata Seiryo University
Riga Stradins University
University of Zimbabwe
Concordia University
Stanford University School of Medicine
University Medical Center Utrecht
Royal Women's Hospital, Carlton
Harvard T.H. Chan School of Public Health
London School of Hygiene & Tropical Medicine
The University of Queensland
McGill Faculty of Medicine and Health Sciences
Hospital Universitari Germans Trias i Pujol
Charité – Universitätsmedizin Berlin
The George Washington University School of Medicine and Health Sciences
Iran University of Medical Sciences
Prince of Wales Hospital Hong Kong
University of Technology Sydney
Lady Davis Institute for Medical Research
New York University
University of Notre Dame
College of Health Sciences
Technische Universität München
Monash University
Keele University, School of Medicine
Universiteit Maastricht
University of Toronto
University of York
SKKU School of Medicine
University of Washington
University of Texas MD Anderson Cancer Center
Universidade Federal de Pelotas
Icahn School of Medicine at Mount Sinai
Faculty of Medicine, Nursing and Health Sciences
Stanford University
King's College London
Max Rady College of Medicine, University of Manitoba
Asahikawa Medical University
Stanford Law School
Istituto Superiore Di Sanita
University of Manitoba
Singapore Institute of Mental Health
Shimane University Faculty of Medicine
Duke University
Universidade de São Paulo
Universität Leipzig
Maastricht Universitair Medisch Centrum+
Goethe-Universität Frankfurt am Main
Centre Universitaire de Santé McGill
Johns Hopkins Bloomberg School of Public Health
Universitätsklinikum Hamburg-Eppendorf
University of Ioannina
Bar-Ilan University
School of Medical Sciences, Universiti Sains Malaysia
Université McGill
Universiteit van Amsterdam
Tan Tock Seng Hospital
Universiti Kebangsaan Malaysia
Instituto Nacional de Psiquiatría Ramon de la Fuente
College of Medical, Veterinary & Life Sciences
Universidad de Buenos Aires
Johns Hopkins School of Medicine
Cumming School of Medicine
University of Cape Town
Healthcare Group Sint-Kamillus
Hospital Mesra Bukit Padang
Private Practice for Psychotherapy and Psycho-oncology
STAR-Stress
TPO Nepal
NRG Oncology Statistics and Data Management Center
Butabika National Referral and Teaching Mental Hospital
Other Contributor(s)
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.