Identification of depression in diabetes: the efficacy of PHQ-9 and HADS-D

Abstract

Clinical guidelines advise screening for depression in patients with diabetes. The Patient Health Questionnaire (PHQ-9) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) are commonly used in primary care. AimTo compare the efficacy of HADS-D and PHQ-9 in identifying moderate to severe depression among primary care patients with type 2 diabetes. Design of studySelf-report postal survey, clinical records assessed by GPs. SettingSeven metropolitan and rural general practices in Victoria, Australia. MethodPostal questionnaires were sent to all patients with diabetes on the registers of seven practices in Victoria. A total of 561 completed postal questionnaires were returned, giving a response rate 47%. Surveys included demographic information, and history of diabetes and depression. Participants completed both the PHQ-9 and HADS-D. Clinical data from patient records included glycosylated hemoglobin (HbA1c) levels and medications. ResultsThe proportion of the total sample completing HADS-D was 96.8% compared with 82.4% for PHQ-9. Level of education was unrelated to responses on the HADS-D but was related to completion of the PHQ-9. Using complete data (n = 456) from both measures, 40 responders showed HADS-D scores in the moderate to severe range, compared with 103 cases identified by PHQ-9. Only 35 cases were classified in the moderate to severe category by both the PHQ-9 and HADS-D. Items with the highest proportions of positive responses on the PHQ-9 were related to tiredness and sleeping problems and, on the HADS-D, feeling slowed down. ConclusionIt may be that the items contributing to the higher prevalence of moderate to severe depression using the PHQ-9 are due to diabetes-related symptoms or sleep disorders.

Measuring depression severity in general practice: discriminatory performance of the PHQ-9, HADS-D, and BDI-II

“…[9][10][11] The current study is able to conclude that, both the HADS-D and the PHQ-9 categorise the severity of depression inaccurately when compared with HRSD-17. The HADS-D tends to place participants in a milder category of depression than the HRSD-17 and the PHQ-9 tends to place individuals in a more severe category.…”

“…Subscales for depression (HADS-D) and anxiety can be totalled, with a possible range for each of 0-21. The scores can then be interpreted as follows: mild (8-10), moderate (11)(12)(13)(14), or severe (≥15) difficulties. PHQ-9.…”

“…The PHQ-9 consists of nine questions, rated 0-3 according to the increased frequency of difficulty experienced in each area covered. Scores, with a possible range of 0-27, are summed and can then be interpreted as follows: no depression (0), minimal (1-5), mild (6-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), or severe (≥20) depression.…”

Prevalence and Determinants of Depression among Type 2 Diabetic Patients in Tabuk City, Saudi Arabia

“…3 Diabetes is a major contributor to the global burdenof disease and a growing number of studies showlinks between depression and diabetes. [4][5][6][7] The rate of depression in people with diabetes is much higher than in the general population. 8 A meta-analysis including 20 controlled studies found that the riskof depression in the diabetic groups was two-foldhigher than that in the non-diabetic comparisongroups.…”

PHQ-9: sensitivity to change over time

“…3,4 Indeed, the most recent of these findings is reported by Reddy and colleagues on the pages following Malpass et al's piece. 5 We should not be comforted by the observation that patients' believe their depression is being better assessed by this process until it is shown that this belief matches the evidence.…”