Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

Ishihara, Miyabi; Harel, Daphna; Levis, Brooke; Levis, Alexander W.; Riehm, Kira E.; Saadat, Nazanin; Azar, Marleine; Rice, Danielle B; Sanchez, Tatiana A.; Chiovitti, Matthew J.; Cuijpers, Pim; Gilbody, Simon; Ioannidis, John P. A.; ., .; McMillan, Dean; Patten, Scott B.; Shrier, Ian; Arroll, Bruce; Bombardier, Charles H.; Butterworth, Peter; Clover, Kerrie; Conwell, Yeates; Goodyear‐Smith, Felicity; Greeno, Catherine G.; Hambridge, John; Harrison, Patricia A.; Hudson, Marie; Kiely, Kim M.; Pence, Brian W.; Rooney, Alasdair G; Sidebottom, Abbey; Simning, Adam; Turner, Alyna; White, Jennifer; Whooley, Mary A.; Winkley, Kirsty; Benedetti, Andrea; Thombs, Brett D.

doi:10.1002/da.22841

Cited by 17 publications

(16 citation statements)

References 53 publications

(84 reference statements)

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“…This allowed us to test whether the sensitivity and specificity of the PHQ-8 was similar to that of the PHQ-9, up to a pre-specified maximum clinically acceptable difference, that is, an equivalence margin (Walker and Nowacki, 2011). In the present study, an equivalence margin of δ = 0.05 was used, which is the same margin that was used in a previous study that used the same IPD database (Ishihara et al ., 2019). CIs for the differences between PHQ-8 and PHQ-9 sensitivity and specificity at each cutoff were constructed via a cluster bootstrap approach (van der Leeden et al ., 1997; 2008), with resampling at the study and subject level.…”

Section: Methodsmentioning

confidence: 99%

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis

et al. 2019

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BackgroundItem 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.MethodsWe conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.Results16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).ConclusionsPHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

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Section: Methodsmentioning

confidence: 99%

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis

et al. 2019

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“…Data on socio-demographic information (gender, age, education, marital status and work status) was collected through questions A1-A5 of the 12 item self-report version of the WHODAS 2.0. During the course of the intervention, the PHQ-4 ( Ishihara et al, 2019 ; Kroenke et al, 2009 ) was used to monitor depressive symptoms.…”

Section: Methodsmentioning

confidence: 99%

Step-by-step: Feasibility randomised controlled trial of a mobile-based intervention for depression among populations affected by adversity in Lebanon

Heim

Ramia

Hana

et al. 2021

Internet Interventions

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Background E-mental health interventions may help to bridge the mental health treatment gap. Evidence on their effectiveness is compelling in high-income countries. Not enough evidence has been generated on their use with communities affected by adversity in low- and middle-income countries. The World Health Organization (WHO), the National Mental Health Programme (NMMP) at Ministry of Public Health (MoPH) in Lebanon and other partners have adapted a WHO intervention called Step-by-Step for use with Lebanese and displaced people living in Lebanon. Step-by-Step is a minimally guided, internet-based intervention for adults with depression. In this study, a feasibility randomised controlled trial (RCT) and a qualitative process evaluation were conducted to explore the feasibility and the acceptability of the research methods, and the intervention, in preparation for two fully powered trials to assess the effectiveness and cost-effectiveness of Step-by-Step in Lebanon. Method Participants were recruited through social media. Inclusion criteria were: being able to understand and speak Arabic or English; access to an internet connected device; aged over 18; living in Lebanon; scores above cut-off on the Patient Health Questionnaire and the WHO Disability Assessment Schedule 2.0. Participants were randomly assigned to the intervention or enhanced care as usual. They completed post-assessments eight weeks after baseline, and follow-up assessments another three months later. Primary outcomes were depression and level of functioning, secondary outcomes were anxiety, post-traumatic stress, and well-being. Qualitative interviews were conducted to evaluate the feasibility and acceptability of the research procedures and the intervention. Results A total of N = 138 participants, including 33 Syrians, were recruited and randomised into two equal groups. The dropout rate was higher in the control group (73% post- and 82% follow-up assessment) than in the intervention group (63% post- and 72% follow-up assessment). The intervention was perceived as relevant, acceptable and beneficial to those who completed it. Suggestions were made to further adapt the content and to make the intervention more engaging. Statistical analyses were conducted despite the small sample size. Complete cases analysis showed a statistically significant symptom reduction in depression, anxiety, disability, and post-traumatic stress, and statistically significant improvement in well-being and functioning. Intention-to-treat analysis revealed non-significant effects. Conclusion The research design, methods and procedures are feasible and acceptable in the context of Lebanon and can be applied in the RCTs. Preliminary findings suggest that Step-by-Step may be effective in reducing symptoms of depression and anxiety and improving functioning and well-being.

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“…Recently, OTA has demonstrated value in developing short forms of PROs [45,46]. It offers an appealing solution for determining a replicable and reproducible short form.…”

Section: Discussionmentioning

confidence: 99%

Nonrestorative sleep scale: a reliable and valid short form of the traditional Chinese version

Fong

Wong

et al. 2020

Qual Life Res

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Purpose Previous research has suggested the essential unidimensionality of the 12-item traditional Chinese version of the Nonrestorative Sleep Scale (NRSS). This study aimed to develop a short form of the traditional Chinese version of the NRSS without compromising its reliability and validity. Methods Data were collected from 2 cross-sectional studies with identical target groups of adults residing in Hong Kong. An iterative Wald test was used to assess differential item functioning by gender. Based on the generalized partial credit model, we first obtained a shortened version such that further shortening would result in substantial sacrifice of test information and standard error of measurement. Another shortened version was obtained by the optimal test assembly (OTA). The two shortened versions were compared for test information, Cronbach's alpha, and convergent validity. Results Data from a total of 404 Chinese adults (60.0% female) who had completed the Chinese NRSS were gathered. All items were invariant by gender. A 6-item version was obtained beyond which the test performance substantially deteriorated, and a 9-item version was obtained by OTA. The 9-item version performed better than the 6-item version in test information and convergent validity. It had discrimination and difficulty indices ranging from 0.44 to 2.23 and − 7.58 to 2.13, respectively, and retained 92% of the test information of the original 12-item version. Conclusion The 9-item Chinese NRSS is a reliable and valid tool to measure nonrestorative sleep for epidemiological studies.

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Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

Cited by 17 publications

References 53 publications

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis

Step-by-step: Feasibility randomised controlled trial of a mobile-based intervention for depression among populations affected by adversity in Lebanon

Nonrestorative sleep scale: a reliable and valid short form of the traditional Chinese version

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