The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility

Saman Maroufizadeh,Amir Almasi-Hashiani,Reza Omani-Samani,Payam Amini,Mahdi Sepidarkish

doi:10.1186/s12978-019-0802-x

Abstract

BackgroundDepression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility.MethodsIn this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7.ResultsThe mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms.ConclusionBoth PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.

Highlights

Depression in patients with infertility often goes undiagnosed and untreated
A variety of self-administered instruments have been developed for assessment of depression
Our finding showed that depression was more common in women, patients with unsuccessful treatment, and patients with long duration of infertility

Summary

Introduction

Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. It has been known to cause negative psychological, social, and emotional consequences worldwide especially in developing countries like Iran [2] Among these consequences, depression is one of the most prevalent psychiatric disorders and adversely affects quality of life and well-being [3,4,5,6]. Depression can be assessed by several instruments such as the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory-II (BDI-II), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9). Among these instruments, the PHQ-9 is one of the most frequently used measures of depression in psychology research. A twoitem version (i.e. PHQ-2) was developed as an ultrabrief instrument for settings with a limited time frame (e.g., survey research or telephone interviews) [14]

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