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 accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Figures
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“The PHQ-9 has been demonstrated to have excellent psychometric properties in previous samples [28, 58].”
From Internet videoconferencing delivered cognitive behavior therapy for generalized anxiety disorder: protocol for a randomized controlled trial (2022) · cites this paper as [58]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
Statistical Analysis With Missing Data
Lahiff, M., Little, R. J. A., & Rubin, D. B. (1989) · Journal of the American Statistical Association · doi:10.2307/2289883 · Cited by 17,385
Spitzer, R. L. (1999) · JAMA · doi:10.1001/jama.282.18.1737 · Cited by 9,802
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., & Wang, P. S. (2003) · JAMA · doi:10.1001/jama.289.23.3095 · Cited by 7,988
The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003) · Medical Care · doi:10.1097/01.mlr.0000093487.78664.3c · Cited by 6,359
Statistical Analysis With Missing Data
Ghosh, S., Little, R. J. A., & Rubin, D. B. (1988) · Technometrics · doi:10.2307/1269814 · Cited by 4,730
The Structured Clinical Interview for DSM-III-R (SCID): I: History, Rationale, and Description
Spitzer, R. L. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820080032005 · Cited by 4,336
Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study
Spitzer, R. L. (1994) · JAMA · doi:10.1001/jama.272.22.1749 · Cited by 2,648
Review: a gentle introduction to imputation of missing values.
Donders, A. R. T., van der Heijden, G. J. M. G., Stijnen, T., & Moons, K. G. M. (2006) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2006.01.014 · Cited by 2,582
Self-citationUtility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME-MD 1000 Study
Spitzer, R. L. (1994) · JAMA · doi:10.1001/jama.1994.03520220043029 · Cited by 1,873
The Structured Clinical Interview for DSM-III-R (SCID)
Williams, J. B. W. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820080038006 · Cited by 1,641
Gilbody, S., Richards, D., Brealey, S., & Hewitt, C. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0333-y · Cited by 1,290
Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., Falloon, K., & Hatcher, S. (2010) · The Annals of Family Medicine · doi:10.1370/afm.1139 · Cited by 1,279 · cited 3×
“Furthermore, very few studies validated the accuracy of the PHQ-2[10,12,16,17].”
BackgroundResultPrevalence and incidence studies of anxiety disorders: A systematic review of the literature
Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2006) · The Canadian Journal of Psychiatry · doi:10.1177/070674370605100206 · Cited by 1,114
LOWE, B. (2004) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00237-9 · Cited by 1,060
A critical look at methods for handling missing covariates in epidemiologic regression analyses.
Greenland, S., & Finkle, W. D. (1995) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117592 · Cited by 891 · cited 1×
“complete case analysis) leads to biased results[23-26].”
Diez-Quevedo, C., Rangil, T., Sanchez-Planell, L., Kroenke, K., & Spitzer, R. L. (2001) · Psychosomatic Medicine · doi:10.1097/00006842-200107000-00021 · Cited by 649
Spitzer, R. L., Williams, J. B. W., & Kroenke, K. (1999) · PsycTESTS Dataset · doi:10.1037/t02598-000 · Cited by 590
Prevalence and Incidence Studies of Mood Disorders: A Systematic Review of the Literature
Waraich, P., Goldner, E. M., Somers, J. M., & Hsu, L. (2004) · The Canadian Journal of Psychiatry · doi:10.1177/070674370404900208 · Cited by 522 · cited 1×
“Second, the prevalence of major depressive disorder in this study was relatively high [30-32].”
BackgroundDiagnostic accuracy of the mood module of the patient health questionnaire: a systematic review
Wittkampf, K. A., Naeije, L., Schene, A. H., Huyser, J., & van Weert, H. C. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.06.004 · Cited by 493
Adewuya, A. O., Ola, B. A., & Afolabi, O. O. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.05.021 · Cited by 474
Spitzer, R. L. (1999) · Medical Entomology and Zoology · Cited by 429
Li, C., Friedman, B., Conwell, Y., & Fiscella, K. A. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01103.x · Cited by 334
The Feasibility of Using the Spanish PHQ-9 to Screen for Depression in Primary Care in Honduras
Wulsin, L. R., Somoza, E. C., & Heck, J. E. (2002) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.v04n0504 · Cited by 240
McManus, D. D., Pipkin, S. S., & Whooley, M. A. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.06.037 · Cited by 226
King, M., Walker, C., Levy, G., Bottomley, C., Royston, P., Weich, S., Bellón-Saameño, J. Á., Moreno, B., Švab, I., Rotar, D., et al. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.12.1368 · Cited by 221
Self-citationGilbody, S. M., Richards, D. A., & Barkham, M. (2007) · Europe PMC (PubMed Central) · Cited by 206
Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population
Bijl, R. V., de Graaf, R., Ravelli, A., Smit, F., & Vollebergh, W. (2002) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-002-0566-3 · Cited by 204
Lamers, F., Jonkers, C. C. M., Bosma, H., Penninx, B. W. J. H., Knottnerus, J. A., & van Eijk, J. T. M. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.07.018 · Cited by 188
Diagnostic interviewing for family studies
Sobin, C. A., Weissman, M. M., Goldstein, R. B., Adams, P. J., WICKRAMARATNE, P. J., Warner, V., & Lish, J. D. (1993) · Psychiatric Genetics · doi:10.1097/00041444-199324000-00005 · Cited by 132
Prediction of depression in European general practice attendees: the PREDICT study
King, M., Weich, S., Torres‐González, F., Švab, I., Maaroos, H., Neeleman, J., Xavier, M., Morris, R. W., Walker, C., Bellón, J. Á., et al. (2006) · BMC Public Health · doi:10.1186/1471-2458-6-6 · Cited by 96
Self-citationPersoons, P., Luyckx, K., Desloovere, C., Vandenberghe, J. U., & Fischler, B. (2003) · General Hospital Psychiatry · doi:10.1016/s0163-8343(03)00072-0 · Cited by 83
Logistic Regression with Missing Values in the Covariates
Vach, W. (1994) · Lecture notes in statistics · doi:10.1007/978-1-4612-2650-5 · Cited by 82
Screening for depressive disorders in patients with skin diseases: a comparison of three screeners
Picardi, A., Adler, D., Abeni, D., Chang, H., Pasquini, P., Rogers, W., & Bungay, K. (2005) · Acta Dermato Venereologica · doi:10.1080/00015550510034966 · Cited by 62
Small Signal, Big Noise: Performance of the CIDI Depression Module
Kurdyak, P. A., & Gnam, W. (2005) · The Canadian Journal of Psychiatry · doi:10.1177/070674370505001308 · Cited by 41
Screening for maternal depression in a low education population using a two item questionnaire
Cutler, C., Legano, L. A., Dreyer, B., Fierman, A., Berkule, S. B., Lusskin, S., Tomopoulos, S., Roth, M., & Mendelsohn, A. (2007) · Archives of Women's Mental Health · doi:10.1007/s00737-007-0202-z · Cited by 37
Hosmer (1997) · doi:10.1002/(sici)1097-0258(19970515)16:9
Research works printed but not linked: 3
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th Text Revision edn. 2000, Washington, D.C.: American Psychiatric Association
- 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
- Kosinsky M: Scoring the SF-12 Physical and Mental Health Summary Measures. Medical Outcomes Trust Bulletin. 1997, 5: 3-4.
Cited by
Sorted by citations
Manea, L., Gilbody, S., & McMillan, D. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2014.09.009 · Cited by 795
Costantini, L., Pasquarella, C. I. M., Odone, A., Colucci, M. E., Costanza, A., Serafini, G., Aguglia, A., Murri, M. B., Brakoulias, V., Amore, M., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.131 · Cited by 827
Zhang, Y., Liang, W., Zuo-ming, C., Zhang, H., Zhang, J.-H., Weng, X., Yang, S.-C., Zhang, L., Shen, L.-J., & Zhang, Y. (2013) · Asia-Pacific Psychiatry · doi:10.1111/appy.12103 · Cited by 456
Santos, I. S., Tavares, B. F., Munhoz, T. N., Almeida, L. S. P. D., Silva, N. T. B. D., Tams, B. D., Patella, A. M., & Matijasevich, A. (2013) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2013001200006 · Cited by 415
Moriarty, A. S., Gilbody, S., McMillan, D., & Manea, L. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.06.012 · Cited by 372
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
- Venue
- BMC Family Practice
- Published
- 2010-12
- Volume
- 11
- Issue
- 1
- Pages
- 98-98
- ISSN
- 1471-2296 (ISSN-L)
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
