Validating the Patient Health Questionnaire-9 (PHQ-9) for screening of depression in Tanzania

Fawzi, Mary C. Smith; Ngakongwa, Fileuka; Liu, Yuanyuan; Rutayuga, Theonest; Siril, Hellen; Somba, Magreat; Kaaya, Sylvia

doi:10.1016/j.npbr.2018.11.002

Cited by 41 publications

(40 citation statements)

References 29 publications

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“…Two recent studies have identi ed a similar cut-off of ≥9 as optimal (36). For example, a validation study in Dar es Salaam, Tanzania revealed an optimal cut-off score of 9 with a sensitivity of 78% and speci city of 87%, with a similar internal consistency to our study (α = 0.83) and slightly higher AUROC (0.87) (21). Another validation study of the PHQ-9 in South Africa among patients with chronic conditions revealed an optimal cut-off score of ≥9, with a sensitivity of 49%, a speci city of 94% and reasonable internal consistency (α = 0.76) (20).…”

Section: Discussionsupporting

confidence: 83%

“…An additional validation study of the PHQ-9 from South Africa showed that a cut-off of 9 achieved a sensitivity of 49% and speci city of 94%, with a diagnostic odds ratio of 14 and AUROC of 0.85 (20). Another PHQ-9 validation study in Tanzania showed that an optimal cut-off of 9 achieved a sensitivity of 78% and speci city of 87% with a good overall accuracy (AUROC= 0.87) (21). Last, a validation study in Malawi showed that using the optimal cut-point of ≥9, the PHQ-9 had a sensitivity of 64% and a speci city of 94% in detecting both minor and major depression, with high overall discrimination (AUROC = 0.93); (22).…”

Section: Introductionmentioning

confidence: 99%

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Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Cumbe

Muanido

Manaca

et al. 2020

Preprint

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Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique.Methods: The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool.Results: The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach’s alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. Conclusions: The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Cumbe

Muanido

Manaca

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…An additional validation study of the PHQ-9 from South Africa showed that a cut-off of 9 achieved a sensitivity of 49% and specificity of 94%, with a diagnostic odds ratio of 14 and AUROC of 0.85 (20). Another PHQ-9 validation study in Tanzania showed that an optimal cut-off of 9 achieved a sensitivity of 78% and specificity of 87% with a good overall accuracy (AUROC = 0.87) (21). The large variability in existing validation results using similar PHQ-9 cut-off points indicate a need to adapt and evaluate the performance of the PHQ-9 in diverse contexts prior to implementation.…”

Section: Introductionmentioning

confidence: 99%

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Cumbe

Muanido

Manaca

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique. Methods: The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 503 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool. Results: The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach’s alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. Conclusions: The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.

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“…A prior validation study was performed in a primary health care setting in Tanzania, which demonstrated that a lower cut-off score of '9' maximized the sensitivity and specificity for identifying major depression in this setting. Therefore, a score of '9' or above was used to reflect an elevated level of depressive symptoms consistent with major depression in this study [33]. The PHQ-9 has demonstrated good internal consistency (Cronbach's alpha ranging from 0.86 to 0.89) and criterion validity (sensitivity and specificity of 88%).…”

Section: Methodsmentioning

confidence: 99%

“…Within the selected study clusters, women were eligible for participation if they were at least 18 years old, up to 30 weeks of gestation, HIV-positive and receiving ART, demonstrated symptoms consistent with MDD on the Patient Health Questionnaire-9 (PHQ-9) of a score of '9' or above, planned to continue their post-partum care at the study facility, and without a current plan to harm herself, including the intent to commit suicide. A cut-off score of '9' for the PHQ-9 was used based on the results from a prior validation study in Tanzania [33]. If the woman had suicidal thoughts a formal referral to the psychiatric nurse at the facility was made.…”

Section: Study Participant Selection and Recruitmentmentioning

confidence: 99%

Healthy Options: study protocol and baseline characteristics for a cluster randomized controlled trial of group psychotherapy for perinatal women living with HIV and depression in Tanzania

et al. 2020

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Background: Perinatal women accessing prevention of mother-to-child transmission of HIV (PMTCT) services are at an increased risk of depression; however, in Tanzania there is limited access to services provided by mental health professionals. This paper presents a protocol and baseline characteristics for a study evaluating a psychosocial support group intervention facilitated by lay community-based health workers (CBHWs) for perinatal women living with HIV and depression in Dar es Salaam.Methods: A cluster randomized controlled trial (RCT) is conducted comparing: 1) a psychosocial support group intervention; and 2) improved standard of mental health care. The study is implemented in reproductive and child health (RCH) centers providing PMTCT services. Baseline characteristics are presented by comparing sociodemographic characteristics and primary as well as secondary outcomes for the trial for intervention and control groups. The trial is registered under clinicaltrials.gov (NCT02039973).Results: Among 742 women enrolled, baseline characteristics were comparable for intervention and control groups, although more women in the control group had completed secondary school (25.2% versus 18.2%). Overall, findings suggest that the population is highly vulnerable with over 45% demonstrating food insecurity and 17% reporting intimate partner violence in the past 6 months. Conclusions: Baseline characteristics for the cluster RCT were comparable for intervention and control groups. The trial will examine the effectiveness of a psychosocial support group intervention for the treatment of depression among women living with HIV accessing PMTCT services. A reduction in the burden of depression in this vulnerable population has implications in the short-term for improved HIV-related outcomes and for potential long-term effects on child growth and development.Trial registration: The trial is registered under clinicaltrials.gov (NCT02039973).

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Validating the Patient Health Questionnaire-9 (PHQ-9) for screening of depression in Tanzania

Cited by 41 publications

References 29 publications

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Healthy Options: study protocol and baseline characteristics for a cluster randomized controlled trial of group psychotherapy for perinatal women living with HIV and depression in Tanzania

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