A study of the diagnostic accuracy of the PHQ-9 in primary care elderly

Abstract

BackgroundThe diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) for assessment of depression in elderly persons in primary care settings in the United States has not been previously addressed. Thus, the purpose of this study was to evaluate the test performance of the PHQ-9 for detecting major and minor depression in elderly patients in primary care.MethodsA prospective study of diagnostic accuracy was conducted in two primary care, university-based clinics in the Pacific Northwest of the United States. Seventy-one patients aged 65 years or older participated; all completed the PHQ-9 and the 15-item Geriatric Depression Scale (GDS) and underwent the Structured Clinical Interview for Depression (SCID). Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, and likelihood ratios (LRs) were calculated for the PHQ-9, the PHQ-2, and the 15-item GDS for major depression alone and the combination of major plus minor depression.ResultsTwo thirds of participants were female, with a mean age of 78 and two chronic health conditions. Twelve percent met SCID criteria for major depression and 13% minor depression. The PHQ-9 had an area under the curve (AUC) of 0.87 (95% confidence interval [CI], 0.74-1.00) for major depression, while the PHQ-2 and the 15-item GDS each had an AUC of 0.81 (95% CI for PHQ-2, 0.64-0.98, and for 15-item GDS, 0.70-0.91; P = 0.551). For major and minor depression combined, the AUC for the PHQ-9 was 0.85 (95% CI, 0.73-0.96), for the PHQ-2, 0.80 (95% CI, 0.68-0.93), and for the 15-item GDS, 0.71 (95% CI, 0.55-0.87; P = 0.187).ConclusionsBased on AUC values, the PHQ-9 performs comparably to the PHQ-2 and the 15-item GDS in identifying depression among primary care elderly.

Accuracy of three depression screening scales to diagnose major depressive episodes in older adults without neurocognitive disorders

“…9 In a study with older adults, the PHQ-9 (cutoff X 10) had sensitivity of 63% and specificity of 82%. 15 In contrast, our study showed a much better diagnostic profile for the PHQ-9, since the same cutoff value had sensitivity and specificity of 94% for the identification of a major depressive episode. The diagnostic performance of the HDRS-17 was similar to that of the PHQ-9.…”

Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Depression: A Randomized Controlled Trial

“…A total score ≥ 10 has been identified as an important threshold for identifying DSM-IV congruent depression with increasing scores indicating greater symptom severity (Kroenke et al, 2001). The PHQ-9 has been found to have good psychometric properties generally (Kroenke, Spitzer, Williams, & Löwe, 2010;Titov, Dear, McMillan, et al, 2011) and in older adults (Phelan et al, 2010). Cronbach's alpha for the PHQ-9 in the current study was .84.…”

Magnesium Intake and Depression in Adults

“…The PHQ was comparable with the Geriatric Depression Screen in a convenience sample of elderly primary care patients. 33 The existence of an emotional paradox in elders, 34 however, in which older adults experience higher levels of well-being despite cognitive and physical decline, may influence how depression is identified and scaled in this group and may make the PHQ less sensitive.…”