Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients

Abstract

OBJECTIVE:The Patient Health Questionnaire depression scale (PHQ-9) is a well-validated, Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criterion-based measure for diagnosing depression, assessing severity and monitoring treatment response. The performance of most depression scales including the PHQ-9, however, has not been rigorously evaluated in different racial/ethnic populations. Therefore, we compared the factor structure of the PHQ-9 between different racial/ethnic groups as well as the rates of endorsement and differential item functioning (DIF) of the 9 items of the PHQ-9. The presence of DIF would indicate that responses to an individual item differ significantly between groups, controlling for the level of depression. MEASUREMENTS:A combined dataset from 2 separate studies of 5,053 primary care patients including non-Hispanic white (n =2,520), African American (n =598), Chinese American (n =941), and Latino (n =974) patients was used for our analysis. Exploratory principal components factor analysis was used to derive the factor structure of the PHQ-9 in each of the 4 racial/ethnic groups. A generalized MantelHaenszel statistic was used to test for DIF. RESULTS:One main factor that included all PHQ-9 items was found in each racial/ethnic group with a coefficients ranging from 0.79 to 0.89. Although endorsement rates of individual items were generally similar among the 4 groups, evidence of DIF was found for some items. CONCLUSIONS:Our analyses indicate that in African American, Chinese American, Latino, and non-Hispanic white patient groups the PHQ-9 measures a common concept of depression and can be effective for the detection and monitoring of depression in these diverse populations.

Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru

“…Prevalence of depression among T2D patients is high when compared with general population (Huang et al ., 2006; Heckbert et al ., 2010; Al‐Amer et al ., 2011), varying from 5% to 60% according to the results of a previous meta‐analysis (Anderson et al ., 2001). Our results found that more than one in 10 patients presented moderately severe or severe depression; although when the usual PHQ‐9 cutoff of 10 was used, prevalence increased to 33.6% (data not shown).…”

A telephonic intervention for promoting occupational re-integration in work-disabled individuals with musculoskeletal pain

“…The PHQ-9 is a nine-item questionnaire that asks respondents to indicate the frequency with which they experience each of the nine symptoms considered in the diagnostic criteria for major depression [28]. The PHQ-9 has been shown to be a valid and reliable measure of depressive symptoms in patients with a variety of medical conditions [11,14,19].…”

Routine Screening for Depression: Identifying a Challenge for Successful HIV Care

“…The PHQ-9 can be self-administered or interviewer-administered and is well-validated in the United States as a dual-purpose instrument that yields both a measure of depression severity and criteria-based diagnoses of DSM-IV depressive disorders: major depressive disorder (MDD), other depressive disorder (ODD), and any depressive disorder (i.e., MDD or ODD). 25,26 It has also been successfully used in diverse populations, specifically those with HIV. 26,27 Rather than using the differences in diagnoses of ODD and MDD, we dichotomized the depressive disorder diagnoses (depressive disorder versus minimal or no depressive symptoms), since the nine items from the instrument provide a method to calculate a count of symptoms and severity to identify these disorders.…”