How reliable is depression screening in alcohol and drug users? A validation of brief and ultra-brief questionnaires
Abstract
Background Depression is highly comorbid with alcohol and drug problems, resulting in greater impairment, reduced treatment adherence and poor outcomes. Little evidence exists to support the use of mental health screening tools in routine addiction treatment. This study tested the validity and reliability of PHQ-9 and PHQ-2 as depression case finding tools in an outpatient drug treatment sample in the United Kingdom.Methods A sample of 103 patients took part in diagnostic assessments using CIS-R and completed brief screening questionnaires. A subgroup of 60 patients completed retests after 4 weeks. Diagnostic results were compared to brief measures using receiver operating characteristic (ROC) curves. Psychometric properties were also calculated to evaluate the validity and reliability of self-completed questionnaires.Results A PHQ-9 score ≥ 12 had a sensitivity of 81% and specificity of 75% for major depression, also displaying good retest reliability (intra-class correlation, 0.78) and internal consistency (Cronbach's alpha, 0.84). PHQ-2 had 68% sensitivity and 70% specificity, with more modest retest reliability (0.66) and internal consistency (0.64).Limitations Diagnostic interviews did not consider the temporal sequencing of the onset of drug use and mental health problems.Conclusions PHQ-9 is a valid and reliable depression screening tool for drug and alcohol users. The brevity and ease of administration of self-completed questionnaires make them useful clinical tools in addiction services commonly encountering a high prevalence of depression.
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Only one prior validation of the PHQ-9 and GAD-7 exists in a substance use disorder sample, and it was outpatient.
“In fact, to our knowledge the PHQ-9 and the GAD-7 have only been validated once in a SUD population and that was in an outpatient setting (Delgadillo et al., 2011; Delgadillo et al., 2012).”
From Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation (2021) · cites this paper as Delgadillo et al., 2011
When using the Delgadillo et al. (2011) cut-off with SUD outpatients, sensitivity was 90% and specificity was 37%.
“Similarly, when using the cut off scores obtained by Delgadillo et al. (2011) with SUD outpatients, sensitivity was 90%, and specificity was 37%.”
From Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation (2021) · cites this paper as Delgadillo et al., 2011
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- Authors
- Delgadillo, J., Payne, S., Gilbody, S., Godfrey, C., Gore, S., Jessop, D., & Dale, V.
- Affiliations
- Leeds Community Healthcare NHS Trust (GB)
- University of York (GB)
- Corresponding author
- Delgadillo, Jaime
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 134
- Issue
- 1-3
- Pages
- 266-271
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2088221351
- Cited by
- 62
- References
- 52
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 6 · 2014: 5 · 2013: 7 · 2012: 4
- FWCI
- 6.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- 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 › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- depression screening, PHQ-9, PHQ-2, alcoholism, drug use disorders, addiction treatment, psychometric validation, sensitivity and specificity, test-retest reliability, internal consistency, major depressive disorder, comorbidities
- MeSH terms
- Adult, Depression, Major Depressive Disorder, Depressive Disorder, Female, United Kingdom, Humans, Male, Mass Screening, Middle Aged, Psychometrics, Surveys and Questionnaires, Sensitivity and Specificity, Reproducibility of Results, Substance-Related Disorders, Drug Users, Young Adult
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