Abstract
BackgroundFor the treatment of depression in diabetes patients, it is important that depression is recognized at an early stage. A screening method for depression is the patient health questionnaire (PHQ-9). The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression in diabetes patients in outpatient clinics.Methods197 diabetes patients from outpatient clinics in the Netherlands filled in the PHQ-9. Within 2 weeks they were approached for an interview with the Mini Neuropsychiatric Interview. DSM-IV diagnoses of Major Depressive Disorder (MDD) were the criterion for which the sensitivity, specificity, positive- and negative predictive values and Receiver Operator Curves (ROC) for the PHQ-9 were calculated.ResultsThe cut-off point of a summed score of 12 on the PHQ-9 resulted in a sensitivity of 75.7% and a specificity of 80.0%. Predictive values for negative and positive test results were respectively 93.4% and 46.7%. The ROC showed an area under the curve of 0.77.ConclusionsThe PHQ-9 proved to be an efficient and well-received screening instrument for MDD in this sample of diabetes patients in a specialized outpatient clinic. The higher cut-off point of 12 that was needed and somewhat lower sensitivity than had been reported elsewhere may be due to the fact that the patients from a specialized diabetes clinic have more severe pathology and more complications, which could be recognized by the PHQ-9 as depression symptoms, while instead being diabetes symptoms.
Highlights
For the treatment of depression in diabetes patients, it is important that depression is recognized at an early stage
Of the 395 eligible patients, 198 were unable to be reached within 2 weeks after they had filled in the PHQ-9, so data on 197 participants were included in our analyses (49.8% of the eligible patients)
There were a total of 197 MIni Neuropsychiatric Interview (MINI), 81.2% were negative for Major Depressive Disorder (MDD) (N = 160) and 18.8% were positive for MDD (N = 37)
Summary
For the treatment of depression in diabetes patients, it is important that depression is recognized at an early stage. The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression in diabetes patients in outpatient clinics. The recognition of depression is very important and the Patient Health Questionnaire (PHQ-9) was developed for this purpose [4,5] This instrument has van Steenbergen-Weijenburg et al BMC Health Services Research 2010, 10:235 http://www.biomedcentral.com/1472-6963/10/235 already been validated for primary care patients, cardiac patients in general hospitals [6], and diabetes patients in primary care [7], but not for diabetes patients in specialized outpatient clinics. The effect of symptom overlap on the performance of screening instruments for depression, such as the PHQ9 [4], would be that higher cut-off points are necessary to correctly identify MDD in the chronically ill than in a population with less severe illnesses. The overall effect would be that both sensitivity and specificity would decline
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