Abstract
BackgroundThe diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) for assessment of depression in elderly persons in primary care settings in the United States has not been previously addressed. Thus, the purpose of this study was to evaluate the test performance of the PHQ-9 for detecting major and minor depression in elderly patients in primary care.MethodsA prospective study of diagnostic accuracy was conducted in two primary care, university-based clinics in the Pacific Northwest of the United States. Seventy-one patients aged 65 years or older participated; all completed the PHQ-9 and the 15-item Geriatric Depression Scale (GDS) and underwent the Structured Clinical Interview for Depression (SCID). Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, and likelihood ratios (LRs) were calculated for the PHQ-9, the PHQ-2, and the 15-item GDS for major depression alone and the combination of major plus minor depression.ResultsTwo thirds of participants were female, with a mean age of 78 and two chronic health conditions. Twelve percent met SCID criteria for major depression and 13% minor depression. The PHQ-9 had an area under the curve (AUC) of 0.87 (95% confidence interval [CI], 0.74-1.00) for major depression, while the PHQ-2 and the 15-item GDS each had an AUC of 0.81 (95% CI for PHQ-2, 0.64-0.98, and for 15-item GDS, 0.70-0.91; P = 0.551). For major and minor depression combined, the AUC for the PHQ-9 was 0.85 (95% CI, 0.73-0.96), for the PHQ-2, 0.80 (95% CI, 0.68-0.93), and for the 15-item GDS, 0.71 (95% CI, 0.55-0.87; P = 0.187).ConclusionsBased on AUC values, the PHQ-9 performs comparably to the PHQ-2 and the 15-item GDS in identifying depression among primary care elderly.
Highlights
The diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) for assessment of depression in elderly persons in primary care settings in the United States has not been previously addressed
Because brief screening tools may be preferable for use in primary care settings, we examined the sensitivity and specificity of the Patient Health Questionnaire-2 (PHQ-2), an abbreviated version of the PHQ9, in identifying patients with major and minor depression
area under the curve (AUC) values using the broadened definition of depression were: PHQ-9 = 0.85; PHQ-2 = 0.80; and 15-item Geriatric Depression Scale (GDS) = 0.71; P = 0.187 for comparison of AUCs for the three instruments
Summary
The diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) for assessment of depression in elderly persons in primary care settings in the United States has not been previously addressed. The purpose of this study was to evaluate the test performance of the PHQ-9 for detecting major and minor depression in elderly patients in primary care. The incidence of major depression in the general elderly population is approximately 15% per year and doubles after age 70 [1]. The prevalence of depression is higher in medical settings than in the community. Depression is quite responsive to treatment, and antidepressants are as effective for older adults as for younger individuals [1]. Care management has been shown to improve outcomes for elderly who are depressed and treated in primary care settings [9].
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