Evaluation of the 9–Item Patient Health Questionnaire (PHQ–9) as an Assessment Instrument for Symptoms of Depression in Patients with Multiple Sclerosis
Abstract
Background Patients with multiple sclerosis (MS) have a high prevalence of depression, but there are concerns regarding assessment of possible depression status using rating scales, such as the 9-item Patient Health Questionnaire (PHQ-9). The idea has been proposed that PHQ-9 scores are contaminated by the MS symptoms of fatigue and impaired concentration, decreasing the validity of measurement. Objectives To determine the extent to which scores on the PHQ-9 are contaminated by patients reporting symptoms attributable to MS. Methods Baseline PHQ-9 scores from an ongoing prospective cohort study of depression in patients with MS (N = 173) were compared with those of a general population sample (N = 3304). Depression prevalence estimates for the MS and general population samples were calculated using conventional algorithm and cutoff point scoring methods, as well as modified scoring methods, excluding fatigue and concentration deficits. Correlations between scores on adjusted scoring methods were analyzed. The proportion that each item contributed to total PHQ-9 scores was also calculated. A logistic regression model evaluated the relationship between symptom severity and MS status corrected for age, sex, and other depressive symptoms. Results Conventional PHQ-9 algorithm and cutoff point scoring yielded 2-week prevalence estimates of 9.8% and 21.4%, respectively, in patients with MS, and 3.3% and 8.4%, respectively, in the general population. In both samples, conventional and…
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The PHQ-9 has been validated in MS.
“The PHQ-9 has been validated in MS46,47 and provides clinical cut-points.”
From Ecological momentary assessment of pain, fatigue, depressive, and cognitive symptoms reveals significant daily variability in multiple sclerosis (2017) · cites this paper as [47]
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- Authors
- Sjonnesen, K., Berzins, S., Fiest, K. M., Bulloch, A. G. M., Metz, L. M., Thombs, B. D., & Patten, S. B.
- Affiliations
- University of Calgary (CA)
- McGill University (CA)
- Corresponding author
- Patten, Scott B.
- ORCID
- Venue
- Postgraduate Medicine
- Publisher
- Informa UK Limited
- Published
- 2012-09
- Volume
- 124
- Issue
- 5
- Pages
- 69-77
- ISSN
- 0032-5481 (ISSN-L)
- 1941-9260
- OpenAlex
- W2065029747
- Cited by
- 68
- References
- 7
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 9 · 2019: 7 · 2018: 6 · 2017: 6 · 2016: 9 · 2015: 8 · 2014: 6 · 2013: 4
- FWCI
- 4.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Postgraduate Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Alberta Innovates
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- multiple sclerosis, depression, PHQ-9, Patient Health Questionnaire, depression screening, fatigue, concentration difficulties, depression prevalence, guilt
- MeSH terms
- Algorithms, Depression, Depressive Disorder, Humans, Multiple Sclerosis, Psychiatric Status Rating Scales, Surveys and Questionnaires, Comorbidity, Logistic Models
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