Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.

Objective We examine the reliability and validity of the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) – which combines the PHQ-9 and GAD-7 scales – as a composite measure of depression and anxiety. Methods Baseline data from 896 patients enrolled in 2 primary-care based trials of chronic pain and 1 oncology-practice based trial of depression and pain were analyzed. The internal reliability, standard error of measurement (SEM), and convergent, construct, and factor structure validity, as well as sensitivity to change of the PHQ-ADS were examined. Results The PHQ-ADS demonstrated high internal reliability (Cronbach's alpha of 0.8 to 0.9) in all 3 trials. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety), and the estimated SEM was approximately 3 to 4 points. The PHQ-ADS showed strong convergent (most correlations 0.7-0.8 range) and construct (most correlations 0.4-0.6 range) validity when examining its association with other mental health, quality of life and disability measures. PHQ-ADS cutpoints of 10, 20, and 30 indicated mild, moderate, and severe levels of depression/anxiety, respectively. Bi-factor analysis showed sufficient unidimensionality of the PHQ-ADS score. PHQ-ADS change scores at 3 months differentiated (P < .0001) between individuals classified as worse, stable, or improved by a reference measure, providing preliminary evidence for sensitivity to change. Conclusions The PHQ-ADS may be a reliable and valid composite measure of depression and anxiety which, if validated in other populations, could be useful as a single measure for jointly assessing two of the most common psychological conditions in clinical practice and research. Trial Registration clinicaltrials.gov Identifier: NCT00926588 (SCOPE); NCT00386243 (ESCAPE); NCT00313573 (INCPAD);

BACKGROUND: Depression greatly burdens subSaharan Africa, especially populations living with HIV/ AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dualpurpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings. OBJECTIVE:To assess the validity/reliability of PHQ-9 and PHQ-2. DESIGN: Observational, two occasions 7 days apart.PARTICIPANTS: A total of 347 patients attending psychosocial support groups.MEASUREMENTS: Demographics, PHQ-9, PHQ-2, general health perception rating and CD4 count. RESULTS:Rates for PHQ-9 DSM-IV major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder were 13%, 21% and 34%. Depression was associated with female gender, but not CD4. Construct validity was supported by: (1) a strong association between PHQ-9 and general health rating, (2) a single major factor with loadings exceeding 0.50, (3) item-total correlations exceeding 0.37 and (4) a pattern of item means similar to US validation studies. Four focus groups indicated culturally relevant content validity and minor modifications to the PHQ-9 instructions. Coefficient alpha was 0.78. Test-retest reliability was acceptable: (1) intraclass correlation 0.59 for PHQ-9 total score, (2) kappas 0.24, 0.25 and 0.38 for PHQ-9 MDD, ODD and any depressive disorder and (3) weighted kappa 0.53 for PHQ-9 depression severity categories. PHQ-2 ≥3 demonstrated high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively, for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) subgroups.CONCLUSIONS: PHQ-9 and PHQ-2 appear valid/ reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in western Kenya. INTRODUCTIONMore than 70% of all deaths attributable to HIV/AIDS are in sub-Saharan Africa, with approximately 6.1% of adults living with HIV in Kenya in 2005 1 . The social, economic and health impact of depression in sub-Saharan Africa is also great, where depression is associated with mortality 2-5 , work disability 4-7 , lower quality of life 5,[8][9][10][11][12] , risk of heart disease 13 and high-risk behaviors for contracting HIV infection 14 . With one exception 15 , the sparse literature on depression among individuals living with HIV/AIDS in sub-Saharan Africa has shown elevated rates of depression relative to community samples 3,8,10,[16][17][18][19][20][21][22][23][24][25] , consistent with western countries [26][27][28][29] . Thus, there is an urgency to incorporating mental health into HIV/ AIDS treatment programs in sub-Saharan Africa, including western Kenya [30][31][32][33][34][35] .Depression in sub-Saharan Africa presents in forms (culturespecific idioms, somatic, based on interpersonal relationships or spiritual in nature) that may o...