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

The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index.

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

Open access
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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Figure 1 Flow chart of the inclusion of patients.CC BY · PubMed Central

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Research works printed but not linked: 3

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th Text Revision edn. 2000, Washington, D.C.: American Psychiatric Association
  2. Ter Smitten RH, Smeets RMW, Van den Brink W: Composite International Diagnostic Interview - computerized version 2.1: Dutch translation and adaptation. 2007, World Health Organisation: Geneva; 1997
  3. Kosinsky M: Scoring the SF-12 Physical and Mental Health Summary Measures. Medical Outcomes Trust Bulletin. 1997, 5: 3-4.

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Metadata

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
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
Licence
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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