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Predictive Validity of the Patient Health Questionnaire-9 for Depression in Poststroke Patients: A Systematic Review
Junya Chen1,2, Mei Chan Chong1, Hmwe Nant Thin Thin1
1Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Background:
The Patient Health Questionnaire-9 (PHQ-9), known for its brevity and ease of use, is employed by researchers and clinical practitioners for poststroke depression (PSD) screening. However, the effectiveness of the PHQ-9 in PSD screening remains to be further validated.
Methods:
Electronic searches were conducted in EMBASE, PubMed, Web of Science, CNKI, and Wanfang databases using keywords including stroke, depression, and PHQ-9. The assessment tool Quality Assessment of Diagnostic Accuracy Studies-2 was utilized to evaluate the risk of bias in diagnostic studies.
Results:
A total of 2049 articles were retrieved, with 9 meeting the inclusion criteria. The PHQ-9 demonstrated pooled sensitivity and specificity of 0.84 and 0.90, respectively, and a summary receiver operating characteristic (sROC) curve of 0.93. At the 10-cut-off value, pooled sensitivity, specificity, and sROC were 0.77, 0.85, and 0.86, respectively. At the 9-cut-off value, the sensitivity, specificity, and sROC were 0.87, 0.85, and 0.92, respectively. At the 5-cut-off value, sensitivity, specificity, and sROC are 0.90, 0.91, and 0.96, respectively. No publication bias was identified.
Conclusion:
The PHQ-9 is an effective tool for screening poststroke depressive symptoms with significant clinical utility. However, further research is needed to establish optimal diagnostic thresholds.
