Utility of PHQ-2, PHQ-8 and PHQ-9 for detecting major depression in primary health care: a validation study in Spain

Gómez-Gómez, Irene; Benítez, Isabel; Moreno-Peral, Patricia; Oliván-Blázquez, Bárbara; Clavería, Ana Murcia; Zabaleta‐del‐Olmo, Edurne; Llobera, Joan; Serrano-Ripoll, María Jesús; Tamayo-Morales, Olaya; Motrico, Emma

doi:10.1017/s0033291722002835

Cited by 11 publications

(30 citation statements)

References 67 publications

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“…Our search identified 367 distinct articles; 26 underwent full-text review, yielding 10 studies 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 for this systematic review ( Figure 1 ). One study 32 focused solely on the PHQ-2, 7 studies 23 , 24 , 25 , 26 , 28 , 29 , 31 evaluated the PHQ-9, and 2 studies 27 , 30 examined both the PHQ-2 and PHQ-9.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, given the paucity of studies identified in this review, we were unable to evaluate the performance of the PHQ-2 and PHQ-9 compared with each standardized clinical interview, which may be understudied in Spanish-speaking or specific subpopulations . Finally, of all 10 studies in this review, not 1 measured the test-retest reliability; thus, conclusions on consistency of screening tests through time are difficult to make.…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, while our review was intended to inform depression screening for US Spanish-speaking patient populations, we found few studies of use of the Spanish-language tools in the US. Another limitation is the high rate of unknown blinding which resulted in indeterminate risk of bias for many of our included studies . This unknown information could affect the accuracy of results but reflects the current scope of knowledge about these widely used tools.…”

Section: Discussionmentioning

confidence: 99%

“…34,49 Instead, the Spanish-language PHQ-2 validation studies 27,30,32 reported lower optimal cutoff scores, ranging from less than or equal to 1 to lower than or equal to 2; we could therefore be missing large numbers of Spanish-speaking patients with depression. Likewise, for the Spanish-language PHQ-9, optimal cutoff scores ranged from 5 to 12, [23][24][25][26][27][28][29][30] with only 2 studies 25,26 identifying 10 as the optimal cutoff score, such as was identified for the original English-language tool 10 and repeat validation studies in primary care settings for English-speaking patients. 50 The variability in PHQ-2 and PHQ-9 cutoff scores could reflect systemic differences between Spanish-and English-speaking populations, methodological differences in the studies evaluating the Spanish-language tool, or a combination of these factors.…”

Section: Discussionmentioning

confidence: 99%

“…Limon et al 22 included a total of 4 studies published between 2009 and 2015, none of which examined the PHQ-2 or PHQ-9. Since 2015, there have been several PHQ-2– and PHQ-9–specific studies published, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 which prompts the need for an updated systematic examination of the literature.…”

Section: Introductionmentioning

confidence: 99%

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Validity of the Spanish-Language Patient Health Questionnaires 2 and 9

Martinez,

Teklu,

Tahir

et al. 2023

JAMA Netw Open

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ImportanceReliable screening for major depressive disorder (MDD) relies on valid and accurate screening tools.ObjectiveTo examine the validity, accuracy, and reliability of the Spanish-language Patient Health Questionnaires 2 and 9 (PHQ-2 and PHQ-9) to screen for MDD.Data SourcesPubMed, Web of Science, Embase, and PsycINFO from data initiation through February 27, 2023.Study SelectionEnglish- and Spanish-language studies evaluating the validity of the Spanish-language PHQ-2 or PHQ-9 in screening adults for MDD compared with a standardized clinical interview (gold standard). Search terms included PHQ-2, PHQ-9, depression, and Spanish.Data Extraction and SynthesisTwo reviewers performed abstract and full-text reviews, data extraction, and quality assessment. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Random-effects meta-analyses of sensitivity, specificity, and area under the curve (AUC) were performed. Internal consistency was evaluated using Cronbach α and McDonald ψ.Main Outcomes and MeasuresTest accuracy and internal consistency. The PHQ-2 is composed of the first 2 questions of the PHQ-9 (targeting core depression symptoms of depressed mood and anhedonia; a score of 3 or higher (score range, 0-6) is generally considered a positive depression screen. If a patient screens positive with the PHQ-2, a follow-up assessment with the PHQ-9 and a clinical diagnostic evaluation are recommended. Once depression is diagnosed, a PHQ-9 score of 10 or higher (score range, 0-27) is often considered an acceptable threshold for treating depression.ResultsTen cross-sectional studies involving 5164 Spanish-speaking adults (mean age range, 34.1-71.8 years) were included; most studies (n = 8) were in primary care settings. One study evaluated the PHQ-2, 7 evaluated the PHQ-9, and 2 evaluated both the PHQ-2 and PHQ-9. For the PHQ-2, optimal cutoff scores ranged from greater than or equal to 1 to greater than or equal to 2, with an overall pooled sensitivity of 0.89 (95% CI, 0.81-0.95), overall pooled specificity of 0.89 (95% CI, 0.81-0.95), and overall pooled AUC of 0.87 (95% CI, 0.83-0.90); Cronbach α was 0.71 to 0.75, and McDonald ψ was 0.71. For the PHQ-9, optimal cutoff scores ranged from greater than or equal to 5 to greater than or equal to 12, with an overall pooled sensitivity of 0.86 (95% CI, 0.82-0.90), overall pooled specificity of 0.80 (95% CI, 0.75-0.85), and overall pooled AUC of 0.88 (95% CI, 0.87-0.90); Cronbach α was 0.78 to 0.90, and McDonald ψ was 0.79 to 0.90. Four studies were considered to have low risk of bias; 6 studies had indeterminate risk of bias due to a lack of blinding information.Conclusions and RelevanceIn this systematic review and meta-analysis, limited available evidence supported the use of the Spanish-language PHQ-2 and PHQ-9 in screening for MDD, but optimal cutoff scores varied greatly across studies, and few studies reported on blinding schemes. These results suggest that MDD should be considered in Spanish-speaking individuals with lower test scores. Given the widespread clinical use of the tools and the heterogeneity of existing evidence, further investigation is needed.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validity of the Spanish-Language Patient Health Questionnaires 2 and 9

Martinez,

Teklu,

Tahir

et al. 2023

JAMA Netw Open

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Prevalence of depression and anxiety in women with pelvic floor dysfunctions: A systematic review and meta‐analysis

Peinado Molina,

Martínez Vázquez,

Martínez Galiano

et al. 2024

Intl J Gynecology & Obste

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BackgroundFemale pelvic floor dysfunction (PFD) is a common condition affecting the emotional well‐being of women.ObjectiveTo estimate the prevalence of depressive and anxiety symptoms in women with PFD.Search Strategy, Selection Criteria, Data Collection and AnalysisFollowing prospective registration (PROSPERO CRD42022362095) we conducted a search of three electronic databases (PubMed, Web of Science and Scopus) from inception to April 2023 without language restriction to capture studies reporting the prevalence of depression/anxiety among women with PFD (chronic pelvic pain [CPP], urinary incontinence [UI], pelvic organ prolapse [POP], and/or fecal incontinence [FI]). Only studies with validated tools were included. Data extraction and study quality assessment were performed by two independent reviewers. Stratifying by type of PFD, rates of depression and anxiety were pooled using random effects model computing 95% confidence interval (CI) and assessing heterogeneity using the I2 statistic. Funnel plots were used to detect potential reporting biases and small‐study effects.Main ResultsThe search yielded 767 articles, from which 54 studies containing 632 605 women were included. All the studies were high quality. The prevalence of depression was: CPP 26.8% (95% CI: 19.2–34.4, I2 = 98.7%; 12 studies, 4798 participants with 491 cases; Egger's P value = 0.009); UI 26.3% (95% CI: 19.4–33.2, I2 = 99.9%; 26 studies, a total of 346 114 participants with 25 050 cases; Egger's P value = 0.944); POP 34.9% (95% CI: 24.3–45.6, I2 = 68%; three studies, 297 participants with 104 cases; Egger's P value = 0.973); and FI 25.3% (95% CI: 0.68–49.9, I2 = 99.7%; six studies, 14 663 participants with 1773 cases; Egger's P value = 0.780). The prevalence of anxiety was: CPP 29.5% (95% CI: 16.3–42.7, I2 = 97.7%; nine studies, 2483 participants with 349 cases; Egger's P value = 0.001); UI 46.91% (95% CI: 39.1–54.6, I2 = 99.6%; 11 studies, 198 491 participants with 40 058 cases; Egger's P value = 0.337); and POP 28% (95% CI: 13.6–42.4, I2 = 89%; three studies with 355 participants with 90 cases; Egger's P value = 0.306).ConclusionThe prevalence of mental health illness was variable in the different types of PFDs. This meta‐analysis helps quantify the burden of depression and anxiety in PFD and will help inform the policies regarding screening of emotional well‐being by healthcare professionals engaged in care of women with PFD.

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Reciprocal longitudinal associations between positive body image and wellbeing among early-adult women

Modica,

Markley

2024

Body Image

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Utility of PHQ-2, PHQ-8 and PHQ-9 for detecting major depression in primary health care: a validation study in Spain

Cited by 11 publications

References 67 publications

Validity of the Spanish-Language Patient Health Questionnaires 2 and 9

Validity of the Spanish-Language Patient Health Questionnaires 2 and 9

Prevalence of depression and anxiety in women with pelvic floor dysfunctions: A systematic review and meta‐analysis

Reciprocal longitudinal associations between positive body image and wellbeing among early-adult women

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