The validity and reliability of the PHQ-9 in screening for post-stroke depression

Abstract

Background: Depression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients. Methods: The objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks-2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. Results: In all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach's alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cutoff score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78-0.96). Conclusions: The Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cutoff score of ≥6 for a Thai population.

No effect of tDCS on fatigue and depression in chronic stroke patients: an exploratory randomized sham-controlled trial combining tDCS with computerized cognitive training

“…First, the patients suffered from relatively mild strokes, as reflected in the low NIHSS scores, possibly compromising generalizability of results to more severe patient samples. However, both fatigue and depressive complaints were comparable to previous chronic phase stroke studies (Cumming et al, 2018;Dajpratham et al, 2020;Valko, Bassetti, Bloch, Held, & Baumann, 2008), and a substantial portion of the patients reported symptoms above clinical thresholds.…”

Feasibility of the Hand in Hand Relationship Intervention for Stroke Survivor–Caregiver Dyads: A Randomized Trial

“…The PHQ-9 contains nine items rated on a 4-point scale ranging from not at all to nearly every day , with higher scores representing higher levels of depressive symptoms. The PHQ-9 has been used extensively in stroke and has strong psychometric properties (Dajpratham et al, 2020; Liao et al, 2020; McCarthy et al, 2012; McCarthy et al, 2013; Thomas et al, 2019). Life changes as a result of providing or receiving poststroke care (i.e., changes in subjective well-being, social functioning, physical health) were measured with the BCOS (Bakas et al, 2006).…”

The psychological impact of anxiety and depression on Chinese medical staff during the outbreak of the COVID-19 pandemic: a cross-sectional study

“…This scale is recommended by the Diagnostic and Statistical Manual of Mental Diseases and was published by the American Psychiatric Association for the screening, diagnosis, and severity assessment of anxiety disorders (22). Similarly, the PHQ-9, which comprises 9 items, is a frequently used selfreporting mental health scale for assessing the severity of depressive symptoms (26). Both scales ask participants how often they have suffered from relevant symptoms within the past 14 days.…”