The Validity and Reliability of the Sinhala Translation of the Patient Health Questionnaire (PHQ-9) and PHQ-2 Screener

Abstract

The Patient Health Questionnaire (PHQ-9) was adapted and translated into Sinhala. Sample consisted of 75 participants diagnosed with MDD according to DSM-IV criteria and 75 gender matched controls. Concurrent validity was assessed by correlating total score of PHQ-9 with that of Centre for Epidemiological Studies Depression Scale (CESD). The Structured Clinical Interview for DSM-IV (SCID-II) conducted by a psychiatrist was the gold standard. Mean age of the sample was 33.0 years. There were 91 females (60.7%). There was significant difference in the mean PHQ-9 scores between cases (14.71) and controls (2.55) (P < 0.001). The specificity of the categorical algorithm was 0.97; the sensitivity was 0.58. Receiver operating characteristic (ROC) analysis found that cut-off score of ≥10 had sensitivity of 0.75 and specificity of 0.97. The area under the curve (AOC) was 0.93. The sensitivity of the two-item screener (PHQ-2) was 0.80 and the specificity was 0.97. Cronbach's alpha was 0.90. The PHQ-9 is a valid and reliable instrument for diagnosing MDD in a non-Western population. The threshold algorithm is recommended for screening rather than the categorical algorithm. The PHQ-2 screener has good sensitivity and specificity and is recommended as a quick screening instrument.

Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients

“…Cronbach's α for the PHQ-9 was 0.88, and one-week test-retest reliability was 0.79, indicating good reliability, consistent with research in other countries. 46,48,67,[70][71][72][73][74][75][76][77][78] In the present sample, the PHQ-9 had moderate to strong positive associations with measures of mental health (PHQ-15 and BDI-13), expect for the negative association with WHO-5, indicating good construct validity. Findings of Dum et al 75 showed that the PHQ-9 correlated with BDI-II and with severity levels of alcohol and drug use among substance abuser outpatients.…”

“…The lowest mean score was obtained for item 9 ("Thoughts that you would be better off dead‚ or of hurting yourself in some way"), and the highest one for item 4 ("Feeling tired or having little energy"). Hanwella et al 46 found the items' mean scores ranged from 0.57 to 1.36, with 0.57 being the lowest item mean, found in patients with MDD. The findings of Torres et al 48 showed that overall scores and severity levels were strongly associated with functional and symptom subscales, denoting good construct validity for the PHQ-9.…”

Depressive disorder in patients attending the outpatient department of a tertiary care hospital in Colombo

“…In general, about half the patients with depression are diagnosed by general practitioners. Because of the limited time for clinicians in such settings they could use screening tools such as the CES-D or the Primary Health Questionnaire (PHQ-9) to identify probable depression which can be later confirmed by a more detailed assessment [18].…”

Rating Scales validated for Sri Lankan populations

“…It can also be used to diagnose major depressive disorder (MDD). It has been translated into Sinhala and validated (45).…”