People with diabetes need a lower cut-off than others for depression screening with PHQ-9
Open accessAbstract
AIMS: This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and 'MDD and/or dysthymia' in people with and without type 2 diabetes. METHODS: Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden's index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice. RESULTS: The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden's index and ≥ 5 by the two-stage method for screening for MDD and 'MDD and/or dysthymia' in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and 'MDD and/or dysthymia' among people without diabetes (Youden's index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for 'MDD and/or dysthymia' in people without diabetes. CONCLUSIONS: A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population.
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Additional sub-group analyses for adolescents and young adults with clinically relevant symptoms of depression and/or anxiety (PHQ-9 or GAD-7 score ≧ 7) were conducted.
“additional sub-group analyses for AYA with clinically relevant symptoms of depression and / or anxiety (PHQ-9 or GAD-7 score ≧ 7) [61, 62] were conducted.”
From Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): a randomized controlled pilot trial (2022) · cites this paper as [61]
The Discussion (page unavailable) reports that a PHQ-9 score of ≥7 was the best research-screening cut-off for major depressive disorder among people with diabetes. It does not establish that PHQ-9 ≥7 identifies clinically relevant symptoms in adolescents and young adults, or support a GAD-7 ≥7 anxiety threshold. The cited paper is not evidence that the citing authors conducted the subgroup analyses. (LLM, conf=0.88)
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- Authors
- Cichoń, E., Kiejna, A., Kokoszka, A., Gondek, T. M., Radzio, R., Jastrzębski, A., Andrzejewska, B. E., Alosaimi, F. D., Lloyd, C. E., & Sartorius, N.
- Affiliations
- WSB Merito University in Torun (PL)
- Medical University of Warsaw (PL)
- King Saud University (SA)
- The Open University (GB)
- Corresponding author
- Cichoń, Ewelina
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-10-23
- Volume
- 15
- Issue
- 10
- Pages
- e0240209
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7584169
- OpenAlex
- W3094598913
- Cited by
- 22
- References
- 58
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 5 · 2023: 3 · 2022: 7 · 2021: 3
- FWCI
- 3.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open Research Online - ORO (The Open University) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Eli Lilly and Company
- Sanofi
- 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, depression screening, type 2 diabetes, major depressive disorder, dysthymia, screening cut-off values, Youden index, two-stage screening, psychometric validation, diabetic patients
- MeSH terms
- Patient Health Questionnaire, Major Depressive Disorder, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Poland, Reproducibility of Results, Diabetes Complications
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 ›
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