Cited by 504Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingMental Health Treatment and Access

The DOI matches its Crossref record; 73 of the 76 references it cites were found in a registry or an index; none of the 25 sources its claims cite is checked for support yet.

Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials

Open access

Abstract

Objective: We examine the reliability and validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)—which combines the nine-item Patient Health Questionnaire depression scale and seven-item Generalized Anxiety Disorder scale—as a composite measure of depression and anxiety. Methods: Baseline data from 896 patients enrolled in two primary-care based trials of chronic pain and one oncology-practice–based trial of depression and pain were analyzed. The internal reliability, standard error of measurement, and convergent, construct, and factor structure validity, as well as sensitivity to change of the PHQ-ADS were examined. Results: The PHQ-ADS demonstrated high internal reliability (Cronbach α values of .8 to .9) in all three trials. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety), and the estimated standard error of measurement was approximately 3 to 4 points. The PHQ-ADS showed strong convergent (most correlations, 0.7–0.8 range) and construct (most correlations, 0.4–0.6 range) validity when examining its association with other mental health, quality of life, and disability measures. PHQ-ADS cutpoints of 10, 20, and 30 indicated mild, moderate, and severe levels of depression/anxiety, respectively. Bifactor analysis showed sufficient unidimensionality of the PHQ-ADS score. PHQ-ADS change scores at 3 months differentiated ( p < .0001) between individuals classified as worse, stable, or improved by a reference measure, providing preliminary evidence for sensitivity to change. Conclusions: The PHQ-ADS may be a reliable and valid composite measure of depression and anxiety which, if validated in other populations, could be useful as a single measure for jointly assessing two of the most common psychological conditions in clinical practice and research. Trial Registration : Clinicaltrials.gov Identifier: NCT00926588 (SCOPE); NCT00386243 (ESCAPE); NCT00313573 (INCPAD).

Overview

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Registry

Crossref · 10.1097/psy.0000000000000322

Cites

73 of 73 references verified0 citation errors · 0 not checkable

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32 Own result · 12 Own interpretation · 6 Not checked yet · 3 Own method · 2 No basis given

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  • It may state two separate claims as one. 28
  • Probably not a substantial claim. 5
31 of 31
  • The paper relies on this without support.

    The MHI-5 change classification of worse, unchanged, or improved is a valid reference standard for clinically meaningful change in depression and anxiety symptoms.

    “three MHI-5 change groups (worse, same, improved) were computed for each patient by determining whether the MHI-5 declined or improved by more than 1.0 standard error of measurement (SEM) from baseline to follow-up at 3 months”
    “the comparison of PHQ-ADS change scores among worse, stable, and improved groups as defined by the MHI-5 suggest the PHQ-ADS is sensitive to change over time”
  • The paper relies on this without support.

    Some interventions, such as cognitive-behavioral therapy and certain classes of antidepressants, are effective for both depression and anxiety.

    “some interventions (e.g., cognitive-behavioral therapy; certain classes of antidepressants) are effective for both depression and anxiety”
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Metadata

Authors
Kroenke, K., Wu, J., Yu, Z., Bair, M. J., Kean, J., Stump, T., & Monahan, P. O.
Affiliations
Regenstrief Institute (US)
Corresponding author
Kroenke, Kurt
Venue
Psychosomatic Medicine
Published
2016-07
Volume
78
Issue
6
Pages
716-727
ISSN
  • 0033-3174 (ISSN-L)
  • 1534-7796
OpenAlex
W2397812290
Cited by
504
References
76
Citations by year
2026: 70 · 2025: 80 · 2024: 76 · 2023: 50 · 2022: 69 · 2021: 77 · 2020: 43 · 2019: 18 · 2018: 9 · 2017: 9
FWCI
17.08
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • PMC
Funders
  • U.S. Department of Veterans Affairs (IIR 07-119, IK2 RX000879)
  • National Institutes of Health (UL1TR001108)
  • National Cancer Institute (R01CA115369)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR064081)
  • National Center for Advancing Translational Sciences
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords
depression, anxiety, psychometric validation, reliability statistics, sensitivity to change, chronic pain, cancer pain, primary care, bifactor analysis, unidimensionality, quality of life, disability
MeSH terms
Adult, Aged, Aged, 80 and over, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Veterans, Reproducibility of Results, Young Adult

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