Predictive validity of the patient health questionnaire-9 for depression in poststroke patients : a systematic review and meta-analysis

Abstract

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.