Cited by 218Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessTreatment of Major Depression

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The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study

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Zuithoff, Nicolaas PA, Vergouwe, Yvonne, King, Michael, Nazareth, Irwin, van Wezep, Manja J, Moons, Karel GM, Geerlings, Mirjam I·2010·BMC Family Practice

DOI 10.1186/1471-2296-11-98PMC PMC3009622

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Abstract

Background: There is a need for brief instruments to ascertain the diagnosis of major depressive disorder. In this study, we present the reliability, construct validity and accuracy of the PHQ-9 and PHQ-2 to detect major depressive disorder in primary care. Methods: Cross-sectional analyses within a large prospective cohort study (PREDICT-NL). Data was collected in seven large general practices in the centre of the Netherlands. 1338 subjects were recruited in the general practice waiting room, irrespective of their presenting complaint. The diagnostic accuracy (the area under the ROC curve and sensitivities and specificities for various thresholds) was calculated against a diagnosis of major depressive disorder determined with the Composite International Diagnostic Interview (CIDI). Results: The PHQ-9 showed a high degree of internal consistency (ICC = 0.88) and test-retest reliability (correlation = 0.94). With respect to construct validity, it showed a clear association with functional status measurements, sick days and number of consultations. The discriminative ability was good for the PHQ-9 (area under the ROC curve = 0.87, 95% CI: 0.84-0.90) and the PHQ-2 (ROC area = 0.83, 95% CI 0.80-0.87). Sensitivities at the recommended thresholds were 0.49 for the PHQ-9 at a score of 10 and 0.28 for a categorical algorithm. Adjustment of the threshold and the algorithm improved sensitivities to 0.82 and 0.84 respectively but the specificity decreased from 0.95 to 0.82 (threshold) and from 0.98 to 0.81 (algorithm). Similar results were found for the PHQ-2: the recommended threshold of 3 had a sensitivity of 0.42 and lowering the threshold resulted in an improved sensitivity of 0.81. Conclusion: The PHQ-9 and the PHQ-2 are useful instruments to detect major depressive disorder in primary care, provided a high score is followed by an additional diagnostic work-up. However, often recommended thresholds for the PHQ-9 and the PHQ-2 resulted in many undetected major depressive disorders.

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Authors: Zuithoff, N. P., Vergouwe, Y., King, M., Nazareth, I., van Wezep, M. J., Moons, K. G., & Geerlings, M. I.
Affiliations: University Medical Center Utrecht (NL)
The Royal Free Hospital (GB)
Corresponding author: Geerlings, Mirjam I
ORCID: Zuithoff, Nicolaas PA
King, Michael
Nazareth, Irwin
Moons, Karel GM
Geerlings, Mirjam I
Venue: BMC Family Practice
Publisher: Springer Science and Business Media LLC
Published: 2010-12
Volume: 11
Issue: 1
Pages: 98-98
ISSN: 1471-2296 (ISSN-L)
DOI: 10.1186/1471-2296-11-98
PMC: PMC3009622
OpenAlex: W2083648129
Cited by: 218
References: 37
Citations by year: 2026: 6 · 2025: 23 · 2024: 21 · 2023: 18 · 2022: 9 · 2021: 15 · 2020: 15 · 2019: 12 · 2018: 9 · 2017: 10 · 2016: 21 · 2015: 15 · 2014: 9 · 2013: 16 · 2012: 11
FWCI: 13.32
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
creativecommons.org/licenses/by/2.0 (vor, 12 d)
Locations: BMC Family Practice (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
UCL Discovery (University College London) (submittedVersion)
Funders: European Commission (PREDICT-QL4-CT2002-00683)
ZonMw
Nederlandse Organisatie voor Wetenschappelijk Onderzoek (016.046.360)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords: PHQ-9, PHQ-2, major depressive disorder, depression screening, primary care, diagnostic accuracy, screening thresholds, sensitivity and specificity, construct validity, test-retest reliability, Composite International Diagnostic Interview
MeSH terms: Adult, Aged, Algorithms, Cross-Sectional Studies, Major Depressive Disorder, Female, Humans, Interviews as Topic, Male, Middle Aged, Netherlands, Primary Health Care, Prospective Studies, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, ROC Curve, Sensitivity and Specificity, Reproducibility of Results, General Practice

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The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study

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