Validity of the Patient Health Questionnaire-9 in Assessing Depression Following Traumatic Brain Injury

Fann, Jesse R.; Bombardier, Charles H.; Dikmen, Sureyya; Esselman, Peter C.; Warms, Catherine A.; Pelzer, Erika; Rau, Holly; Temkin, Nancy

doi:10.1097/00001199-200511000-00003

Cited by 359 publications

(257 citation statements)

References 37 publications

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“…Test-retest reliability of 0.59 for PHQ-9 total score is moderate. This ICC was better for older (0.65) and worse for younger (0.51) participants, and lower than previous PHQ-9 studies: 0.71 for a 14-day period among urban Kenyans with cancer 11 , 0.89 for a 30-day period among Nigerian university students 46 and 0.76 to 0.92 for a 7-day period among US and European outpatient samples 56,57,62,73 . However, 0.59 may be acceptable given events between baseline and retest surveys that could have contributed to slight changes in depressive symptoms, including: (1) a national election with civil unrest and (2) some participants attended a support group session (data on who attended was not available).…”

Section: Discussioncontrasting

confidence: 66%

“…Thus, MDD, ODD and any depressive disorder showed fair agreement. In the only study that reported test-retest reliability for PHQ-9 MDD, 7-day kappa was also not substantial (0.46) 62 . Weighted kappa (0.53) suggests there is moderate agreement for PHQ-9 severity categories among western Kenyans.…”

Section: Discussionmentioning

confidence: 86%

“…A significant relationship between the PHQ-9 and general health rating 62,63 or functional impairment scales 53,54,57,60,64,76 supports construct validity, because depression is known to negatively impact perceived health 60 . Analysis of covariance (ANCOVA) was used to compare PHQ-9 diagnostic and severity categories (independent variable) on general health rating (dependent variable), while adjusting, consistent with previous studies 53,54,60 , for gender, age and education (≥ Form 1-2 vs ≤ Standard 4-8).…”

Section: Discussionmentioning

confidence: 90%

“…The PHQ-9 has been validated in western countries regarding construct validity 53,54,57,[59][60][61][62][63][64] , diagnostic accuracy 53,57,58,62,[64][65][66][67][68] , sensitivity to change 61,69,70 , responsiveness to treatment [71][72][73] , internal consistency 56,57,63,65,74,75 , test-retest reliability 56,57,62,73 and realistic estimates of population base rates 74 . The PHQ-2 (i.e., the first two items of the PHQ-9) is an ultra-brief and accurate screening tool 58,[76][77][78] .…”

Section: Introductionmentioning

confidence: 99%

“…The PHQ-9 has been validated in chronically ill populations 58,62,63,79 . However, only one report studied individuals living with HIV (in the US); the PHQ-9 demonstrated better diagnostic accuracy than the provider report 27 .…”

Section: Introductionmentioning

confidence: 99%

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Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales Among Adults Living with HIV/AIDS in Western Kenya

et al. 2008

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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...

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