Racial and Ethnic Differences in the Relationship Between Depression Severity and Functional Status

Huang, Frederick Y.; Chung, Henry; Kroenke, Kurt; Spitzer, Robert L.

doi:10.1176/appi.ps.57.4.498

Cited by 20 publications

(22 citation statements)

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“…With a larger sample size, the difference between MDD and ODD may become significant, because their mean difference on general health rating was similar to the mean difference between ODD and no depressive disorder. The strong relationship between increasing PHQ-9 depression severity and worsening general health rating was consistent with two large US validation samples (see also 60 ), supporting construct validity. Factor analysis revealed acceptably high factor loadings on a major core depressive factor and adequate item discrimination values, supporting construct validity for not only the total sample, but also gender and age subgroups.…”

Section: Discussionsupporting

confidence: 78%

“…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). The false discovery rate method controlled the proportion (0.05) of falsely rejected null hypotheses for multiple post-hoc pair-wise comparisons of depression categories 86,87 .…”

Section: Discussionmentioning

confidence: 91%

“…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%

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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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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 91%

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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“…This reduced variance may account for the lack of difference we saw in the function and dimensionality of the PHQ-9 between groups. Finally, while the construct validity of the PHQ-9 has been examined in a separate analysis of these data, 39 convergent validity of the PHQ-9 in these different ethnic groups with an independent criterion standard such as the SCID would also be a valuable future study. In light of the growing diversity of the U.S. population and the increasingly recognized importance of screening for depression in clinical care, the need for an efficient depression screening instrument that can be used in disparate groups is critical.…”

Section: Discussionmentioning

confidence: 99%

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

Huang¹,

et al. 2006

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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.

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“…Researchers also cannot assume that interventions will have equivalent effects on symptoms and functional impairment outcomes across ethnic groups. For example, the impairment associated with depression symptoms appears to differ between Latinos and Whites (Huang, Chung, Kroenke, & Spitzer, 2006) and less improvement in impairment has been observed in African Americans receiving CBT compared to other groups . A combined quantitative and qualitative approach may help identify the relevant dimensions of symptoms and impairment that are meaningful to ethnic minorities in clinical trials.…”

Section: Assessment Of Outcomesmentioning

confidence: 99%

Methodological challenges in treatment outcome research with ethnic minorities.

Lau¹,

Chang²,

Okazaki³

Methodological Issues and Strategies in Clinical Research (4th Ed.).

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Treatment outcome research focused on ethnic minorities is critically needed to eliminate mental health disparities. Because the conduct of treatment outcome research with ethnic minorities is difficult and complex, we discuss key challenges and present some methodological options suited to provide answers to specific types of questions. We focus first on the randomized clinical trial (RCT) paradigm, reviewing specific challenges facing investigators conducting ethnically inclusive trials. We then highlight the promise of other methods of inquiry to expand the science on mental health treatment with ethnic minorities.

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Racial and Ethnic Differences in the Relationship Between Depression Severity and Functional Status

Abstract: Functional impairment increased with increasing levels of depression severity in all three racial or ethnic groups, although Latinos consistently reported fewer functional disturbances compared with non-Hispanic whites.

Cited by 20 publications

References 0 publications

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

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

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

Methodological challenges in treatment outcome research with ethnic minorities.

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