加拿大蒙特利尔犹太总医院Brett D. Thombs团队分析了单用PHQ-2及联合应用PHQ-9筛查抑郁症的准确性。2020年6月9日，该成果发表在《美国医学会杂志》上。

患者健康问卷抑郁症模块（PHQ-9）是一种9项自我管理式工具，用于检测抑郁症和评估抑郁严重程度。患者健康问卷–2（PHQ-2）由PHQ-9的前2个项目组成，可初步识别患者，以便使用完整的PHQ-9进行评估。

为了评估单独PHQ-2，以及联合PHQ-9检测严重抑郁症的准确性，研究组在Medline、科学引文索引等大型数据库中检索2000年1月至2018年5月的文献，对PHQ-2得分与确诊的严重抑郁症进行比较，并评估单独PHQ-2、以及合并PHQ-9的敏感性和特异性。

最终共纳入100项研究，包括44318名参与者，其中4572例为严重抑郁症（10%），平均年龄为49岁，女性占59%。在使用半结构式访谈的研究中，PHQ-2得分2分及以上的敏感性和特异性分别为0.91和0.67，3分及以上的敏感性和特异性分别为0.72和0.85。与全结构式访谈相比，半结构式访谈的敏感性明显更高。在不同类型的访谈中，特异性并无显著差异。

半结构式访谈的接收者工作特征曲线下面积为0.88，全结构式访谈为0.82，而微访谈（MINI）为0.87。没有显著的亚组差异。对于半结构式访谈，PHQ-2得分2分以上，PHQ-9得分10分以上的敏感性为0.82，与单独PHQ-9得分10分以上（0.86）相比无显著差异；但特异性为0.87，略微高于单独PHQ-9（0.85）。 曲线下面积为0.90。据估计，这种组合将需要完成完整PHQ-9的参与者人数减少了57%。

总之，PHQ-2（分数≥2）与PHQ-9（分数≥10）的组合与单独PHQ-9（分数≥10）相比，敏感性相差不大，但特异性更高。

附：英文原文

Title: Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis

Author: Brooke Levis, Ying Sun, Chen He, Yin Wu, Ankur Krishnan, Parash Mani Bhandari, Dipika Neupane, Mahrukh Imran, Eliana Brehaut, Zelalem Negeri, Felix H. Fischer, Andrea Benedetti, Brett D. Thombs

Issue&Volume: 2020/06/09

Abstract: 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 (44318 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-2scores 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.

DOI: 10.1001/jama.2020.6504

Source: https://jamanetwork.com/journals/jama/article-abstract/2766865