The accuracy of Patient Health Questionnaire-9 in detecting depression and measuring depression severity in high-risk groups in primary care
Abstract
Objective Only half of patients with depressive disorder are diagnosed by their family physicians. Screening in high-risk groups might reduce this hidden morbidity. This study aims to determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) in (a) screening for depressive disorder, (b) diagnosing depressive disorder and (c) measuring the severity of depressive disorder in groups that are at high risk for depressive disorder.Method We compared the performance of the PHQ-9 as a screening instrument and as a diagnostic instrument to that of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview, which we used as reference standard. Three high-risk groups of patients were selected: (a) frequent attenders, (b) patients with mental health problems and (c) patients with unexplained complaints. Patients completed the PHQ-9. Next, patients who were at risk for depression (based on PHQ scores) and a random sample of 20% of patients who were not at risk were selected for a second PHQ-9 and the reference standard (SCID-I). We assessed the adequacy of the PHQ-9 as a tool for severity measurement by comparing PHQ-9 scores with scores on the 17-item Hamilton Depression Rating Scale (HDRS-17) in patients diagnosed with a depressive disorder.Results Among 440 patients, both PHQ-9 and SCID-I were analyzed. The test characteristics for screening were sensitivity=0.93 and specificity=0.85; those for diagnosing were sensitivity=0.68 and specificity=0.95. The positive likelihood ratio for diagnosing was 14.2. The HDRS-17 was administered in 49 patients with depressive disorder. The Pearson correlation coefficient of the PHQ-9 to the HDRS-17 was r=.52 (P<.01).Conclusion The PHQ-9 performs well as a screening instrument, but in diagnosing depressive disorder, a formal diagnostic process following the PHQ-9 remains imperative. The PHQ-9 does not seem adequate for measuring severity.
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The PHQ-9 and GAD-7 have strong internal and test-retest reliability and construct and factor-structure validity.
“The PHQ-9 and GAD-7 have strong internal and test-retest reliability as well as construct and factor-structure validity.20”
From Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials (2016) · cites this paper as [20]
Both the PHQ-9 and GAD-7 have been shown to be sensitive to change when treatment response is monitored.
“Moreover, both measures have proven sensitive to change when monitoring treatment response.20;33-36”
From Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials (2016) · cites this paper as [20]
The PHQ-9 and GAD-7 are among the best validated and most commonly used measures of depression and anxiety, respectively.
“The Patient Health Questionnaire 9-item depression scale (PHQ-9) and 7-item Generalized Anxiety Disorder scale (GAD-7) are among the best validated and most commonly used depression and anxiety measures, respectively.20-25”
From Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials (2016) · cites this paper as [20]
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- Authors
- Wittkampf, K., van Ravesteijn, H., Baas, K., van de Hoogen, H., Schene, A., Bindels, P., Lucassen, P., van de Lisdonk, E., & van Weert, H.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Radboud University Nijmegen (NL)
- Corresponding author
- Wittkampf, Karin
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 31
- Issue
- 5
- Pages
- 451-459
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W2149482727
- Cited by
- 126
- References
- 21
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7 · 2023: 2 · 2022: 7 · 2021: 10 · 2020: 6 · 2019: 11 · 2018: 4 · 2017: 5 · 2016: 8 · 2015: 11 · 2014: 7 · 2013: 14 · 2012: 6
- FWCI
- 10.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Radboud Universitair Medisch Centrum
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- PHQ-9, depression screening, depression severity measurement, high-risk groups, primary care, frequent attenders, SCID-I, Hamilton Depression Rating Scale, diagnostic accuracy, sensitivity and specificity
- MeSH terms
- Depression, Female, Humans, Male, Mass Screening, Middle Aged, Netherlands, Primary Health Care, Surveys and Questionnaires, Sensitivity and Specificity, Severity of Illness Index
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