The Patient Health Questionnaire-9 vs. the Hamilton Rating Scale for Depression in Assessing Major Depressive Disorder.

Simeng Ma,Wei Wang,Lijun Kang,Lihua Yao,Peilin Wang,Qingshan Guo,Hanping Bai,Zhongchun Liu,Ying Wang,Jun Yang,Bingxiang Yang,Xiaofen Zong,Nan Zhang,Li Fang

doi:10.3389/fpsyt.2021.747139

Abstract

Background: The Hamilton Rating Scale for Depression (HAMD-17) has been used for several decades to assess the severity of depression. Multiple studies have documented defects in this scale and deemed it unsuitable for clinical evaluation. The HAMD-6, which is the abbreviated version of HAMD-17, has been shown to be effective in assessing the core symptoms of depression with greater sensitivity than HAMD-17. And the Patient Health Questionnaire-9 (PHQ-9) is suggested as an effective alternative to the HAMD-17 because of its simplicity and ease-of-use.Methods: Research was completed involving 1,741 participants having major depressive disorder. Cronbach's alpha, intraclass correlation coefficient (ICC) and weighted Kappa analysis was used to determine the reliability of the scales. Pearson correlation analysis and factor analysis were used to analyze validity. Item response theory (IRT) was used to analyze psychological characteristics of items in both the HAMD-17 and PHQ-9.Results: Reliability analysis showed that the Cronbach's alpha of the HAMD-17, HAMD-6 and PHQ-9 were 0.829, 0.764, and 0.893 respectively, and the ICC of the three scales ranged from 0.606 to 0.744. The Kappa score of the consistency of depression severity assessment was 0.248. Validity analysis showed that the PHQ-9 was a single factor structure, and the total score of the scale was strongly correlated with the HAMD-17 (r = 0.724, P < 0.001). The IRT analysis showed that the discrimination parameters of the PHQ-9 were higher than that of the HAMD-17 in all dimensions. The HAMD-6 had the lowest measurement accuracy in distinguishing the severity of depression, while the PHQ-9 had the highest measurement accuracy.Conclusion: Results showed that the PHQ-9 was satisfactory in terms of reliability, validity and distinguishing the severity of depression. It is a simple, rapid, effective and reliable tool which can be used as an alternative to the HAMD-17 to assess the severity of depression.

Highlights

Depression is a common psychiatric disorder with high morbidity and mortality and a leading contributor to the global burden of disease [1, 2]
The purpose of this study is to explore whether the Patient Health Questionnaire-9 (PHQ-9) can replace HAMD-17 to better assess the severity of depression
According to PHQ-9 diagnostic algorithm to distinguish depression / no depression, the Kappa coefficient of HAMD-17 and PHQ-9 was 0.526, indicating a moderate level of consistency

Summary

Introduction

Depression is a common psychiatric disorder with high morbidity and mortality and a leading contributor to the global burden of disease [1, 2]. A diagnosis of depression is confirmed using through standardized interviews and assessment scales. The Hamilton Rating Scale for Depression (HAMD-17) is the most commonly used to estimate severity and response to treatment in patients who were already diagnosed with a depressive disorder [3,4,5]. Many questions have been raised about the effectiveness of HAMD-17 assessment and its inapplicability to clinical practice [6], mainly including the following: The HAMD-17 is an observer-rated scale requiring clinician training in its use and takes 20–30 min to complete. The Hamilton Rating Scale for Depression (HAMD-17) has been used for several decades to assess the severity of depression. The HAMD-6, which is the abbreviated version of HAMD-17, has been shown to be effective in assessing the core symptoms of depression with greater sensitivity than HAMD-17. The Patient Health Questionnaire-9 (PHQ-9) is suggested as an effective alternative to the HAMD-17 because of its simplicity and ease-of-use

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Conclusion