External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4
the DEPRESsion Screening Data DEPRESSD PHQ Collaboration
(2022) Methods, volume 204, pp. 300 - 311
(Article)
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
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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.
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Keywords: Equivalence testing, Optimal test assembly, Self-report questionnaire, Sensitivity, Specificity, Molecular Biology, General Biochemistry,Genetics and Molecular Biology
ISSN: 1046-2023
Publisher: Academic Press Inc.
Note: Funding Information: All authors declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years with the following exceptions: Dr. Bernstein declares that he has consulted to Abbvie Canada, Amgen Canada, Bristol Myers Squibb Canada, Roche Canada, Janssen Canada, Pfizer Canada, Sandoz Canada, Takeda Canada, and Mylan Pharmaceuticals. He has also received unrestricted educational grants from Abbvie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada; as well as been on speaker's bureau of Abbvie Canada, Janssen Canada, Takeda Canada and Medtronic Canada, all outside the submitted work. Dr. Chan J CN is a steering committee member and/or consultant of Astra Zeneca, Bayer, Lilly, MSD, and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr. Chan LF declares personal fees and non-financial support from Otsuka, Lundbeck, and Johnson and Johnson; and non-financial support from Ortho-McNeil-Janssen, and Menarini, outside the submitted work. Dr. Hegerl declares that within the last three years, he was an advisory board member for Janssen and received a research grant from Medice, all outside the submitted work. Dr. Inagaki declares that he has received personal fees from Meiji, Mochida, Takeda, Novartis, Yoshitomi, Pfizer, Eisai, Otsuka, MSD, Sumitomo Dainippon, Janssen, and Eli Lilly, all outside of the submitted work. Dr. Pugh declares that she received salary support from Pfizer-Astella and Millennium, outside the submitted work. Dr. Rancans declares that he received grants, personal fees, and non-financial support from Gedeon Richter; personal fees and non-financial support from Lundbeck, Servier, and Janssen Cilag; personal fees from Zentiva, and Abbvie; outside the submitted work. Dr. Schram declares that the primary study by Janssen et al. was supported by unrestricted grants from Janssen, Novo Nordisk, and Sanofi. Dr. Wagner declares that she receives personal fees from Celgene, outside the submitted work. All authors declare no other relationships or activities that could appear to have influenced the submitted work. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2021 Elsevier Inc.
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