Abstract
BackgroundThe Patient Health Questionnaire-9 (PHQ-9), despite its excellent reliability and validity in primary care, has not been examined for administration to psychiatric patients. This study assesses the accuracy of PHQ-9 in screening for major depressive episode and in diagnosing major depressive episode in patients of a psychiatric specialty clinic.MethodsWe compared operational characteristics of PHQ-9 as a screening and diagnostic instrument to DSM-IV-TR diagnosis by a trained psychiatrist as a reference standard. The reference criteria were “current major depressive episode” or “current major depressive episode with major depressive disorder”. PHQ-9 was used with two thresholds: diagnostic algorithm and summary scores (PHQ-9 ≥ 10). The optimal cut-off points of PHQ-9 summary scores were analyzed using a receiver operational characteristics (ROC) curve.ResultsFor “current major depressive episode”, PHQ-9 showed high sensitivity and high negative predictive value at both thresholds, but its specificity and positive predictive value were low. For “current major depressive episode with major depressive disorder”, PHQ-9 also showed high sensitivity and high negative predictive value at both thresholds, but the positive predictive value decreased more than that for “current major depressive episode”. The ROC analysis showed the optimal cut-off score of 13/14 for “current major depressive episode”.ConclusionsPHQ-9 is useful for screening, but not for diagnosis of “current major depressive episode” in a psychiatric specialty clinic.
Highlights
The Patient Health Questionnaire-9 (PHQ-9), despite its excellent reliability and validity in primary care, has not been examined for administration to psychiatric patients
Each had been diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) [7] by a mood disorder specialist psychiatrist (T.I.) who was blinded to the PHQ-9 results and who had more than 20 years of clinical experience in this field of psychiatry
This study revealed that PHQ-9 has high sensitivity and a high negative predictive value in the setting of a clinic specializing in psychiatry as well as in primary care facilities and other specialty clinics [1,3,4,6] so that PHQ-9 is useful for screening purposes for the presence of a current major depressive episode
Summary
The Patient Health Questionnaire-9 (PHQ-9), despite its excellent reliability and validity in primary care, has not been examined for administration to psychiatric patients. This study assesses the accuracy of PHQ-9 in screening for major depressive episode and in diagnosing major depressive episode in patients of a psychiatric specialty clinic. Two recent meta-analyses have shown good pooled sensitivity (0.80 and 0.77, respectively) and specificity (0.92 and 0.94, respectively) for PHQ-9 against the DSM-IV diagnosis of major depressive disorder or major depressive episode in the settings of primary care clinics and clinics other than psychiatric clinics [3,4]. The utility and validity of PHQ-9 for the screening for major depressive episode or major depressive disorder has not been examined in a psychiatric specialty clinic. The utility and limitation of PHQ-9 for patients with psychiatric disorders in psychiatric specialty clinics must be studied before its application to psychiatric practice
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