Correlates of Depressive Symptoms among Middle-Aged and Older Homeless Adults Using the 9-Item Patient Health Questionnaire

Abstract

<jats:p>This study investigates the screening for depressive symptoms among middle-aged and older homeless adults based on Patient Health Questionnaire-9 (PHQ-9) and examines the possible factors associated with their major depressive symptoms. A cross-sectional survey was employed, and research subjects included 129 homeless people aged 45 years old and over in Taipei Wanhua District and Taipei Main Station. We used a structured questionnaire and face-to-face interview conducted by three social workers to collect data in the analyses. The content of the questionnaire included an informed consent form, demographic characteristics, enabling and need factors of healthcare, and PHQ-9 of homeless people. Results revealed that 15.5% respondents were free of depressive symptoms, 16.3% had mild level (score 5–9), 31.8% had moderate level (score 10–14), 26.4% had moderately severe level (score 15–19), and 10.1% had severe level of depressive symptoms (score 20–27). Adopting a PHQ-9 score 10 as a cut-off point for major depressive symptoms, 68.3% of middle-aged and older homeless adults were the cases needing to be referred to healthcare settings for further recheck in the near future. A multiple regression analysis found gender, age, and usage of psychiatric outpatient care were associated with major depressive symptom occurrence. The female participants were less likely to have major depressive symptoms than the male participants (OR = 0.29, 95% CI = 0.09–0.96). The elderly participants were more likely to have major depressive symptoms than the aged 45–54 years (OR = 5.29, 95% CI = 1.44–19.41). Those participants who have ever used psychiatric outpatient care were significantly more correlated with the occurrence of major depressive symptoms than their counterparts (OR = 3.65, 95% CI = 1.46–9.09). The present study suggests that in the future health policy should eliminate the risk factors of depressive symptoms and improve mental healthcare access, to improve the health and wellbeing of the homeless population.</jats:p>

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“…The PHQ-9 is a 9-item depression module from the full Patient Health Questionnaire and is designed to screen for the presence and severity of depression. It has been widely used as a measure of mental health well-being and is applicable to patients from different cultures ( 32 ). As a screening tool for depressive symptoms, the PHQ-9 scores each criterion from “0” (none at all) to “3” (almost daily), with a total score ranging from 0 (no depressive symptoms) to 27 (all symptoms daily) ( 26 ).…”

Factors Associated with Free Hospital Outpatient Service Use among Middle-Aged and Older Urban Homeless Adults in Taipei

“…Evidence on the management of diseases, and the long-term care, treatment and health promotion of homeless adults is sparse, but this information is required in order to provide healthcare, and to assess healthcare use and outcome effectiveness [ 27 , 28 ]. This study aimed to explore the use and associated factors of healthcare services in homeless people to assess the provision of free healthcare in this vulnerable population in Taipei.…”

“…We investigated depressive symptoms, based on the Patient Health Questionnaire-9 (PHQ-9), to examine respondents' mental health. Depression severity was categorized into five levels (determined by the PHQ-9 score): none (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27).…”

“…a PHQ-9, Patient Health Questionnaire-9. b Depression severity category (PHQ-9 score): none (0-4), mild (5-9), moderate(10)(11)(12)(13)(14), moderately severe(15)(16)(17)(18)(19) and severe(20)(21)(22)(23)(24)(25)(26)(27).…”

“…a Low: <3 free outpatient visits; high: ≥3 outpatient visits; b depression severity category (PHQ-9 score): none (0-4), mild (5-9), moderate(10)(11)(12)(13)(14), moderately severe(15)(16)(17)(18)(19), and severe(20)(21)(22)(23)(24)(25)(26)(27); * t-test; § Fisher's exact test.…”