The accuracy of Patient Health Questionnaire-9 in detecting depression and measuring depression severity in high-risk groups in primary care (original) (raw)
Related papers
BMC Family Practice, 2010
Background: There is a need for brief instruments to ascertain the diagnosis of major depressive disorder. In this study, we present the reliability, construct validity and accuracy of the PHQ-9 and PHQ-2 to detect major depressive disorder in primary care. Methods: Cross-sectional analyses within a large prospective cohort study (PREDICT-NL). Data was collected in seven large general practices in the centre of the Netherlands. 1338 subjects were recruited in the general practice waiting room, irrespective of their presenting complaint. The diagnostic accuracy (the area under the ROC curve and sensitivities and specificities for various thresholds) was calculated against a diagnosis of major depressive disorder determined with the Composite International Diagnostic Interview (CIDI).
BMC Psychiatry, 2017
Background: The prevalence of major depressive disorder (MDD) in Spanish primary care (PC) centres is high. However, MDD is frequently underdiagnosed and consequently only some patients receive the appropriate treatment. The present study aims to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) to identify MDD in a subset of PC patients participating in the large PsicAP study. Methods: A total of 178 patients completed the full PHQ test, including the depression module (PHQ-9). Also, a Spanish version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was implemented by clinical psychologists that were blinded to the PHQ-9 results. We evaluated the psychometric properties of the PHQ-9 as a screening tool as compared to the SCID-I as a reference standard. Results: The psychometric properties of the PHQ-9 for a cut-off value of 10 points were as follows: sensitivity, 0.95; specificity, 0.67. Using a cut-off of 12 points, the values were: sensitivity, 0.84; specificity, 0.78. Finally, using the diagnostic algorithm for depression (DSM-IV criteria), the sensitivity was 0.88 and the specificity 0.80. Conclusions: As a screening instrument, the PHQ-9 performed better with a cut-off value of 12 versus the standard cut-off of 10. However, the best psychometric properties were obtained with the DSM-IV diagnostic algorithm for depression. These findings indicate that the PHQ-9 is a highly satisfactory tool that can be used for screening MDD in the PC setting. Keywords: major depressive disorder; primary care; Patient Health Questionnaire-9; psychometric properties; Trial Registration: Current Controlled Trials ISRCTN58437086. Registered 20 May 2013
Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
The Annals of Family Medicine, 2010
PURPOSE Although screening for unipolar depression is controversial, it is potentially an effi cient way to fi nd undetected cases and improve diagnostic acumen. Using a reference standard, we aimed to validate the 2-and 9-question Patient Health Questionnaires (PHQ-2 and PHQ-9) in primary care settings. The PHQ-2 comprises the fi rst 2 questions of the PHQ-9.
BJPsych Open, 2016
BackgroundThe Patient Health Questionnaire (PHQ) is the most commonly used measure to screen for depression in primary care but there is still lack of clarity about its accuracy and optimal scoring method.AimsTo determine via meta-analysis the diagnostic accuracy of the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 questions to detect major depressive disorder (MDD) among adults.MethodWe systematically searched major electronic databases from inception until June 2015. Articles were included that reported the accuracy of PHQ-9 or PHQ-2 questions for diagnosing MDD in primary care defined according to standard classification systems. We carried out a meta-analysis, meta-regression, moderator and sensitivity analysis.ResultsOverall, 26 publications reporting on 40 individual studies were included representing 26 902 people (median 502, s.d.=693.7) including 14 760 unique adults of whom 14.3% had MDD. The methodological quality of the included articles was acceptable. The meta-analytic area ...
Background: The nine-item depression module from the Patient Health Questionnaire (PHQ-9) is widely used as an open access screening instrument for depression in different health care and community settings; thus far, normative data from the general population are still scarce. The objectives of the study were to generate normative data and to further investigate the construct validity and factor structure of the PHQ-9 in the general population. Methods: Nationally representative face-to face household surveys were conducted in Germany between 2003 and 2008 (n=5018). The survey questionnaires included the PHQ-9, the Satisfaction with Life Scale, the 12-item Short Form Health Survey (SF-12) for the measurement of health-related quality of life and demographic characteristics. Results: Normative data for the PHQ-9 were generated for both genders (53.6% female) and different age levels [mean age (S.D.) of 48.9 (18.1) years]. Women had significantly higher mean (S.D.) scores compared with men [3.1 (3.5) vs. 2.7 (3.5)]. A prevalence rate of moderate to high severity of depressive symptoms of 5.6% was identified. Intercorrelations with depression were highest for the Mental Component Scale of the SF-12, followed by the Physical Component Scale of health-related quality of life, and life satisfaction. Results supported a one-factor model of depression. Conclusions: The normative data provide a framework for the interpretation and comparisons of depression with other populations. Evidence supports reliability and validity of the unidimensional PHQ-9 as a measure of depression in the general population.
Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care
BMC Psychiatry, 2012
Background: The Patient Health Questionnaire-9 (PHQ-9), despite its excellent reliability and validity in primary care, has not been examined for administration to psychiatric patients. This study assesses the accuracy of PHQ-9 in screening for major depressive episode and in diagnosing major depressive episode in patients of a psychiatric specialty clinic. Methods: We compared operational characteristics of PHQ-9 as a screening and diagnostic instrument to DSM-IV-TR diagnosis by a trained psychiatrist as a reference standard. The reference criteria were "current major depressive episode" or "current major depressive episode with major depressive disorder". PHQ-9 was used with two thresholds: diagnostic algorithm and summary scores (PHQ-9 ≥ 10). The optimal cut-off points of PHQ-9 summary scores were analyzed using a receiver operational characteristics (ROC) curve. Results: For "current major depressive episode", PHQ-9 showed high sensitivity and high negative predictive value at both thresholds, but its specificity and positive predictive value were low. For "current major depressive episode with major depressive disorder", PHQ-9 also showed high sensitivity and high negative predictive value at both thresholds, but the positive predictive value decreased more than that for "current major depressive episode". The ROC analysis showed the optimal cut-off score of 13/14 for "current major depressive episode".
Psychotherapy and Psychosomatics
Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). Conclusions: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.
Journal of Affective Disorders, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Patients' and physicians' evaluation of the PHQ-D for depression screening
Primary Care and Community Psychiatry, 2005
All rights reserved: reproduction in whole or part not permitted Background: A high number of patients in primary care suffer from depressive disorders. General practitioners (GPs) have an important function in detecting depression at an early stage. There is evidence that the detection of depressive disorders can be optimised by implementing routine screening. Aim: To analyse the acceptability of the PHQ-D as screening tool for depressive disorders in primary care. Design/Setting: Feasibility study in general practices in South Baden (Germany) Methods: 1034 patients of 17 GPs in single practices were screened with the Patient Health Questionnaire and asked to evaluate the screening tool in terms of its acceptability for routine practice. The GPs assessed the complaints and diagnoses of each patient and also evaluated the screening tool in terms of its practicability for daily care. Results: GPs and patients evaluate the screening questionnaire differently, with patients rating the usefulness of the instrument more positively. 50.0% of the GPs rated it as an impediment, whereas 75.8% of the patients evaluated it as feasible for routine. No differences were found between patients with and without depressive symptoms. Conclusion: Patients accept the PHQ-D for assessing depressive symptoms in primary care. The GPs' belief that patients would not accept such questionnaires proved not to be in accordance with the patients' evaluation. More detailed analyses are needed to evaluate the efficiency of the PHQ-D for routine care.