Minimal detectable change of the Patient Health Questionnaire-9, Patient Health Questionnaire-8, and Patient Health Questionnaire-2: individual patient data meta-analysis.

Methods

Individual participant data meta-analysis.

个体参与者数据的荟萃分析。

data_sources

Medline, Medline In-Process and other non-indexed citations, PsycInfo, and Web of Science, 1 January 2000 to 9 May 2018.

Medline、Medline In-Process 及其他非索引引文、PsycInfo 和 Web of Science，2000年1月1日至2018年5月9日。

eligibility_criteria_for_selecti

Datasets from articles in any language if participants were aged ≥18 years, were recruited from any non-psychiatric setting, and were not recruited because they were seeking mental healthcare.

如果参与者年龄≥18岁，是从任何非精神病学环境中招募的，且并非因为寻求心理健康护理而被招募，则来自任何语言文章的数据集。

Eligible datasets had a classification for major depressive disorder or major depressive episode based on a validated semi-structured or fully structured interview conducted within two weeks of administering the PHQ-9, PHQ-8, or PHQ-2.

符合条件的数据集基于在PHQ-9、PHQ-8或PHQ-2施测两周内进行的经过验证的半结构化或全结构化访谈，对重性抑郁障碍或重性抑郁发作进行了分类。

Results

Pooled MDCs across studies were estimated for the PHQ-9, PHQ-8, and PHQ-2 with random effects meta-analysisfor 95% (MDC95), 90% (MDC90), and 67% (MDC67) confidence that change beyond measurement error occurred.

通过随机效应元分析估计了PHQ-9、PHQ-8和PHQ-2的合并最小临床差异（MDCs），其中95%（MDC95）、90%（MDC90）和67%（MDC67）置信区间表示测量误差之外的变化。

PHQ-9, PHQ-8, and PHQ-2 analyses included 42 548 participants (94 studies), 42 592 participants (94 studies), and 44 085 participants (98 studies), respectively.

PHQ-9、PHQ-8和PHQ-2的分析分别包括了42,548名参与者（94项研究）、42,592名参与者（94项研究）和44,085名参与者（98项研究）。

Mean participant age was 49 years (standard deviation 17), and 60% of participants were women.

参与者的平均年龄为49岁（标准差17），其中60%为女性。

Overall, 10% of participants had major depression (range 1-57% across studies).

总体而言，10%的参与者患有重度抑郁症（研究间的范围为1-57%）。

MDC95 was 5.72 points (95% confidence interval(CI) 5.54 to 5.90, 95% prediction interval (PI) 4.00 to 7.44) for the PHQ-9, 5.51 points (95% CI 5.33 to 5.68, 95% PI 3.87 to 7.15) for the PHQ-8, and 2.26 points (95% CI 2.15 to 2.37, 95% PI 1.20 to 3.32) for the PHQ-2.

对于PHQ-9，最小临床差异（MDC95）为5.72分（95%置信区间（CI）5.54至5.90，95%预测区间（PI）4.00至7.44），对于PHQ-8为5.51分（95% CI 5.33至5.68，95% PI 3.87至7.15），对于PHQ-2为2.26分（95% CI 2.15至2.37，95% PI 1.20至3.32）。

For the PHQ-9, MDC95 was highest in inpatient healthcare settings at 6.48 (95% CI 6.05 to 6.92) points.

对于PHQ-9，住院医疗环境中MDC95最高，为6.48（95%置信区间6.05至6.92）分。

MDC95 for the PHQ-9 increased by 0.40 (95% CI 0.25 to 0.55) points for each 10% increase in the proportion of participants with major depression.

对于PHQ-9，每增加10%的主要抑郁症患者比例，MDC95增加0.40（95%置信区间0.25至0.55）分。

Sex and age had minimal or no association.

性别和年龄的关联性最小或没有。

Subgroup and meta-regression findings were similar for the PHQ-8 and PHQ-2.

PHQ-8和PHQ-2的亚组和元回归分析结果相似。

Conclusions

Based on the pooled estimate, a six point difference on the PHQ-9, the PHQ version most used in clinical practice, could be an appropriate MDC threshold in general practice.

基于汇总估计，PHQ-9量表上的六分差异，即临床实践中最常用的PHQ版本，可能是在全科医疗中适当的最小临床重要差异（MDC）阈值。

A higher threshold may be preferred in specialty mental healthcare.

在专科精神卫生保健中，可能更倾向于使用更高的阈值。

MDC67 or MDC90 thresholds would provide less certainty that change has occurred.

MDC67 或 MDC90 阈值将提供较少的确定性，表明变化已经发生。

Alternative strategies, such as using the upper end of a prediction interval, would provide more certainty but a greater likelihood of not recognising change.

使用预测区间的上限等替代策略将提供更多的确定性，但不识别变化的可能性更大。

study_registration

PROSPERO CRD42014010673.

PROSPERO CRD42014010673。