Abstract
BackgroundPeople with chronic health conditions are known to have a higher prevalence of depressive disorder. The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression which has not yet been validated for use on chronic care patients in South Africa.MethodsA sample of 676 chronic care patients attending two primary health facilities in North West Province, South Africa were administered the PHQ-9 by field workers and a diagnostic interview (the Structured Clinical Interview for DSM-IV) (SCID) by clinical psychologists. The PHQ-9 and the PHQ-2 were evaluated against the SCID, as well as for sub-samples of patients who were being treated for HIV infection and for hypertension.ResultsUsing the SCID, 11.4 % of patients had major depressive disorder. The internal consistency estimate for the PHQ-9 was 0.76, with an area under the receiver operator curve (AUROC) of 0.85 (95 % CI 0.82–0.88), which was higher than the AURUC for the PHQ-2 (0.76, 95 % CI 0.73–0.79). Using a cut-point of 9, the PHQ-9 has sensitivity of 51 % and specificity of 94 %. The PHQ-9 AUROC for the sub-samples of patients with HIV and with hypertension were comparable (0.85 and 0.86, respectively).ConclusionsThe PHQ-9 is useful as a screening tool for depression among patients receiving treatment for chronic care in a public health facility.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0503-0) contains supplementary material, which is available to authorized users.
Highlights
People with chronic health conditions are known to have a higher prevalence of depressive disorder
This study aimed to validate the PHQ-9 as a screening tool for depression among chronic care patients attending two public primary health care facilities in South Africa
Descriptive results In the SCID diagnostic interview, more than one in ten (11.47 %) participants were diagnosed as currently experiencing a major depressive episode
Summary
People with chronic health conditions are known to have a higher prevalence of depressive disorder. Depression has been found to be co-morbid with a range of chronic diseases, including HIV/AIDS [3, 4] cardiovascular disorder (CVD) and diabetes [1, 5]. The WHO World Mental Health Survey in developed and developing countries [8] and the review of the evidence by the National Institute for Health and Clinical Excellence (NICE) guidance for depression in adults with a chronic physical health problem reports similar findings [9]. Evidence for the reciprocal relationship between depression and chronic physical health problems suggests a number of causal pathways, including emotional distress and poor sleep due to pain [12], the prospect of disability, [1] and changes in allostatic load whereby the ability of the body to adapt may be compromised due to ongoing tissue damage and degenerative changes [9].
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