Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa

Abstract

Depression is often underdiagnosed and undertreated in primary care settings, particularly in developing countries. This is, in part, due to challenges resulting from a lack of skilled mental health workers, stigma associated with mental illness, and lack of cross-culturally validated screening instruments. We conducted this study to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) questionnaire as a screen for diagnosing major depressive disorder among adults in Ethiopia, the second most populous country in sub-Saharan Africa. A total of 926 adults attending outpatient departments in a major referral hospital in Ethiopia participated in this study. We assessed criterion validity and performance characteristics against an independent, blinded, and psychiatrist administered semi-structured Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. Overall, the PHQ-9 items showed good internal (Cronbach's alpha=0.85) and test re-test reliability (intraclass correlation coefficient=0.92). A factor analysis confirmed a 1-factor structure. Receiver Operating Characteristics (ROC) analysis showed that a PHQ-9 threshold score of 10 offered optimal discriminatory power with respect to diagnosis of MDD via the clinical interview (sensitivity=86% and specificity=67%). The PHQ-9 appears to be a reliable and valid instrument that may be used to diagnose major depressive disorders among Ethiopian adults.

A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression

“…n/a n/a Unclear Fann et al [24] ✗ ✗ ✗ High ? n/a n/a Unclear Gelaye et al [25] ? If studies reported multiple cut-off points, "threshold pre-specified" is coded as not applicable.…”

“…Eighteen studies stated that a self-report version of the PHQ-9 was used [7,22,23,27,28,31-39,42-45]. In one study, it was administered over the telephone [24], and in four studies, it was administered by a clinician [21,25,29,30]. In one study, the PHQ-9 was administered either over the phone or was self-reported [27].…”

“…The remaining studies did not clearly state the method of administration. Translated versions of the PHQ-9 were used in 16 studies, including Amharic [25], Dutch [32,37,44,45], German versions [27,34], Greek [29], Hebrew [21], Italian [38], Japanese [30,35], Persian [31], Spanish [22,36] and Thai [33]. Table 2 summarizes the results of the quality assessment using QUADAS-II.…”

Prevalence and Factors Associated with Depressive Symptoms among Patient with Chronic Kidney Disease (CKD) in Black Lion Specialized Hospital and Saint Paulo’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: Cross Sectional Study

“…An outcome variable (presence of depression) was collected by Patient Health Questionnaire (PHQ-9). PHQ-9 is a 9-item questionnaire, commonly used to screen for symptoms of depression in primary health care and in outpatients and validated in Ethiopia with sensitivity=86% and specificity=67% [15].…”

Relation between body composition at birth and child development at 2 years of age: a prospective cohort study among Ethiopian children

“…The PHQ-9 is a self-report 7 measure used to screen major depressive disorders (MDD). The PHQ_9 has been found to 168 be valid in two studies from Ethiopia in different treatment settings: tertiary hospital 169 medical out-patients (33)and in primary care out-patients in the study area (34). The PHQ-170 9 is composed of nine items asked with a recall period of two weeks.…”