External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4

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.Fil: Harel, Daphna. University of New York; Estados UnidosFil: Levis, Brooke. Keele University; Reino UnidoFil: Sun, Ying. Lady Davis Institute For Medical Research; CanadáFil: Fischer, Felix. Berliner Institut Für Gesundheitsforschung; AlemaniaFil: Ioannidis, John P.A.. University of Stanford; Estados UnidosFil: Cuijpers, Pim. Vrije Universiteit Amsterdam; Países BajosFil: Patten, Scott B.. Cumming School Of Medicine; CanadáFil: Ziegelstein, Roy C.. Johns Hopkins School Of Medicine; Estados UnidosFil: Markham, Sarah. King's College London; Reino UnidoFil: Benedetti, Andrea. Centre Universitaire de Santé Mcgill; CanadáFil: Thombs, Brett D.. Lady Davis Institute For Medical Research; Canadá. Mcgill Faculty Of Medicine And Health Sciences; CanadáFil: He, Chen. Lady Davis Institute For Medical Research; CanadáFil: Wu, Yin. Lady Davis Institute For Medical Research; CanadáFil: Krishnan, Ankur. Lady Davis Institute For Medical Research; CanadáFil: Mani Bhandari, Parash. Lady Davis Institute For Medical Research; CanadáFil: Neupane, Dipika. Lady Davis Institute For Medical Research; CanadáFil: Negeri, Zelalem. Lady Davis Institute For Medical Research; CanadáFil: Imran, Mahrukh. Lady Davis Institute For Medical Research; CanadáFil: Rice, Danielle B.. Lady Davis Institute For Medical Research; CanadáFil: Riehm, Kira E.. Lady Davis Institute For Medical Research; CanadáFil: Azar, Marleine. Lady Davis Institute For Medical Research; CanadáFil: Levis, Alexander W.. Lady Davis Institute For Medical Research; CanadáFil: Boruff, Jill. Université Mcgill; CanadáFil: Gilbody, Simon. University of York; Reino UnidoFil: Kloda, Lorie A.. Concordia University; CanadáFil: Amtmann, Dagmar. University of Washington; Estados UnidosFil: Ayalon, Liat. Bar-ilan University; IsraelFil: Baradaran, Hamid R. Iran University of Medical Sciences; IránFil: Beraldi, Anna. Universitat Technical Zu Munich; AlemaniaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin