Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics

van Steenbergen-Weijenburg, Kirsten M; de Vroege, Lars; Ploeger, Robert R; Brals, Jan W; Vloedbeld, Martijn G; Veneman, Thiemo F; Hakkaart-van Roijen, Leona; Rutten, Frans FH; Beekman, Aartjan TF; van der Feltz-Cornelis, Christina M

doi:10.1186/1472-6963-10-235

Cited by 200Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDiabetes Management and EducationMental Health Treatment and Access

Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics

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van Steenbergen-Weijenburg, Kirsten M, de Vroege, Lars, Ploeger, Robert R, Brals, Jan W, Vloedbeld, Martijn G, Veneman, Thiemo F, Hakkaart-van Roijen, Leona, Rutten, Frans FH +2 more·2010·BMC Health Services Research

DOI 10.1186/1472-6963-10-235PMC PMC2927590

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Abstract

BACKGROUND: For the treatment of depression in diabetes patients, it is important that depression is recognized at an early stage. A screening method for depression is the patient health questionnaire (PHQ-9). The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression in diabetes patients in outpatient clinics. METHODS: 197 diabetes patients from outpatient clinics in the Netherlands filled in the PHQ-9. Within 2 weeks they were approached for an interview with the Mini Neuropsychiatric Interview. DSM-IV diagnoses of Major Depressive Disorder (MDD) were the criterion for which the sensitivity, specificity, positive- and negative predictive values and Receiver Operator Curves (ROC) for the PHQ-9 were calculated. RESULTS: The cut-off point of a summed score of 12 on the PHQ-9 resulted in a sensitivity of 75.7% and a specificity of 80.0%. Predictive values for negative and positive test results were respectively 93.4% and 46.7%. The ROC showed an area under the curve of 0.77. CONCLUSIONS: The PHQ-9 proved to be an efficient and well-received screening instrument for MDD in this sample of diabetes patients in a specialized outpatient clinic. The higher cut-off point of 12 that was needed and somewhat lower sensitivity than had been reported elsewhere may be due to the fact that the patients from a specialized diabetes clinic have more severe pathology and more complications, which could be recognized by the PHQ-9 as depression symptoms, while instead being diabetes symptoms.

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A number of tools have been utilised and validated to screen depression (PHQ-9, HADS) and anxiety (HADS, GAD-7) in diabetes.
“a number of tools have been utilised and validated to screen depression (PHQ-9 [50, 51], HADS [52, 53]) and anxiety (HADS [52], Generalised Anxiety Disorder 7-item scale (GAD-7) [54, 55]) in diabetes.”
From A Consideration of the Psychological Aspects to Managing Patients with Painful Diabetic Neuropathy: An Insight into Pain Management Services at a Tertiary Centre in the UK (2021) · cites this paper as [51]

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“In addition to the measures stated above, a number of tools have been utilised and validated to screen depression (PHQ-9 [50, 51], HADS [52, 53]) and anxiety (HADS [52], Generalised Anxiety Disorder 7-item scale (GAD-7) [54, 55]) in diabetes.”
Method
Impact of New-Onset Postoperative Depression on Readmission Outcomes After Surgical Coronary Revascularization
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Association of Plasma DPP4 Activity and Brain-Derived Neurotrophic Factor With Moderate to Severe Depressive Symptoms in Patients With Type 2 Diabetes: Results From a Cross-Sectional Study
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Risk factors and outcomes of anxiety symptom trajectories in type 2 diabetes: the Fremantle Diabetes Study Phase II
Whitworth, S. R., Bruce, D. G., STARKSTEIN, S. E., Davis, T. M. E., Skinner, T. C., Davis, W. A., & Bucks, R. S. (2020) · Diabetic Medicine · doi:10.1111/dme.14344 · Cited by 13 · see citing works
Factors Associated with Untreated Depression Among Type 2 Diabetic Patients at Halaba Kulito Hospital, South Ethiopia: A Cross-Sectional Study
Azeze, G. A., Adema, B. G., Adella, G. A., Demissie, B. W., & Obsa, M. S. (2020) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s255360 · Cited by 14 · see citing works
Psychometric evaluation of the Norwegian Toronto Alexithymia Scale (TAS‐20) in a multisite clinical sample of patients with personality disorders and personality problems
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The validity of the patient health Questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi
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Screening performance of a short versus long version of the Patient Health Questionnaire-Depression in outpatients with diabetes
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People with diabetes need a lower cut-off than others for depression screening with PHQ-9
Cichoń, E., Kiejna, A., Kokoszka, A., Gondek, T. M., Radzio, R., Jastrzębski, A., Andrzejewska, B. E., Alosaimi, F. D., Lloyd, C. E., & Sartorius, N. (2020) · PLOS ONE · doi:10.1371/journal.pone.0240209 · Cited by 22 · see citing works
Comparison of the CES-D and PHQ-9 depression scales in people with type 2 diabetes in Tehran, Iran
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Validación inicial de Patient Health Questionnaire 2-Item para detectar síntomas depresivos en diabéticos y/o hipertensos en la atención primaria de salud
Martínez, P., Soto-Brandt, G., Brandt, S., Viviana Guajardo, T., & Rojas, G. (2020) · Revista médica de Chile · doi:10.4067/s0034-98872020001101614 · Cited by 6 · see citing works

Authors: van Steenbergen-Weijenburg, K. M., de Vroege, L., Ploeger, R. R., Brals, J. W., Vloedbeld, M. G., Veneman, T. F., Hakkaart-van Roijen, L., Rutten, F. F., Beekman, A. T., & van der Feltz-Cornelis, C. M.
Affiliations: Ziekenhuis Groep Twente (NL)
Erasmus MC (NL)
Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
ORCID: Beekman, Aartjan TF
Venue: BMC Health Services Research
Publisher: Springer Science and Business Media LLC
Published: 2010-08-12
Volume: 10
Issue: 1
Pages: 235-235
ISSN: 1472-6963 (ISSN-L)
DOI: 10.1186/1472-6963-10-235
PMC: PMC2927590
OpenAlex: W2121827707
Cited by: 200
References: 16
Citations by year: 2026: 5 · 2025: 10 · 2024: 20 · 2023: 13 · 2022: 15 · 2021: 12 · 2020: 17 · 2019: 12 · 2018: 17 · 2017: 15 · 2016: 11 · 2015: 14 · 2014: 10 · 2013: 10 · 2012: 12
FWCI: 12.14
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
Locations: BMC Health Services Research (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
Research portal (Tilburg University) (publishedVersion, other-oa)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion, other-oa)
EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
VU Research Portal (publishedVersion, other-oa)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (acceptedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
RePub (Erasmus University Rotterdam) (submittedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: PHQ-9, Patient Health Questionnaire, depression screening, diabetes mellitus, major depressive disorder, screening tool validation, sensitivity and specificity, cut-off values
MeSH terms: Aged, Ambulatory Care Facilities, Depressive Disorder, Major, Major Depressive Disorder, False Positive Reactions, Female, Humans, Interview, Psychological, Male, Mass Screening, Middle Aged, Netherlands, Diabetes Complications

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Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics

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