Performance of the PHQ-9 as a Screening Tool for Depression After Stroke

Abstract

Background and Purpose-The purpose of this study was to examine the performance of the Patient Health Questionnaire (PHQ)-9, a 9-item depression scale, as a screening and diagnostic instrument for assessing depression in stroke survivors. Methods-As part of a randomized treatment trial for poststroke depression (PSD), subjects with and without PSD completed the PHQ-9, a 9-item summed scale, with scores ranging from 0 (no depressive symptoms) to 27 (all symptoms occurring daily). Subjects endorsing 2 or more symptoms of depression were administered the criterion standard Structured Clinical Interview for Depression (SCID). Receiver operating characteristic analysis was used to examine the sensitivity and specificity of the PHQ-9 Results-Of 316 subjects enrolled, 145 met SCID criteria for major depression or other depressive disorder, and 171 were not depressed. PHQ-9 scores discriminated well between subjects with any versus no depressive disorder, with an area under the curve (AUC) of 0.96, as well as between subjects with and without major depression (AUCϭ0.96). The AUC was similar regardless of patient age, gender, or ethnicity. A PHQ-9 score Ն10 had 91% sensitivity and 89% specificity for major depression, and 78% sensitivity and 96% specificity for any depression diagnosis. Conclusions-The PHQ-9 performs well as a brief screener for PSD with operating characteristics similar or superior to other depression measures and similar to its characteristics in a primary care population. Moreover, PHQ-9 scores discriminate equally well between those with and without PSD regardless of age, gender, or ethnicity. Key Words: depression Ⅲ stroke P oststroke depression (PSD) affects approximately onethird of ischemic stroke survivors, is often undiagnosed and inadequately treated, and is associated with increased morbidity and mortality after stroke. 1-4 Depression screening after stroke is thus important but can be complicated by cognitive and physical symptoms of stroke that may introduce additional variability in assessment of depressive symptoms and depression diagnosis. Although several established depression screening instruments have been validated in stroke cohorts, 5-10 these scales can be burdensome for patients to complete, require a trained interviewer to administer, and often are designed only for screening and not as a diagnostic depression tool. The Patient Health Questionnaire 9-item depression scale (PHQ-9) is a 9-item self-administered depression screening and diagnostic tool increasingly used in primary care and other medical populations. 11,12 Although it has excellent measurement properties in other settings, it has not been previously validated in patients with PSD. The purpose of this study was to examine the performance of the PHQ-9 as a screening and diagnostic instrument for assessing depression in ischemic stroke survivors. Subjects and MethodsSubjects were patients enrolled in the National Institute for Neurologic Disorders and Stroke-funded AIM (Activate, Initiate treatment, Monitor) PSD study....

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

“…Consistent with previous research 58,[76][77][78] , the PHQ-2 demonstrated very good operating characteristics. The best cutoff point for sensitivity and specificity (≥3) provided very high specificity for any depressive disorder, an advantage in primary care and resource-constrained HIV clinics, where low specificity creates a problem by generating many false positives.…”

“…The Patient Health Questionnaire-9 (PHQ-9) is the only validated instrument 11,46 that focuses on the nine diagnostic criteria for DSM-IV depressive disorders and is very brief 53 , an advantage in resource-constrained Kenyan clinics. The PHQ-9 can be self-administered 53,54 or interviewer-administered 11,55,56 , and is well validated in the US as a dual-purpose instrument that yields both a measure of depression severity 57,58 and criteria-based diagnoses of DSM-IV depressive disorders 53,54 : major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder (i.e., MDD or ODD).…”

“…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] .…”

“…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] .…”

“…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 .…”