The PHQ-9
Tóm tắt
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.
MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples.
CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Tài liệu tham khảo
Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913–21.
Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression: two questions are as good as many. J Gen Intern Med. 1997;12:439–45.
Keller MB, Kocsis JH, Thase ME, et al. Maintenance phase efficacy of sertraline for chronic depression: a randomized controlled trial. JAMA. 1998;280:1665–72.
McDowell I, Kristjansson E, Newell C. Depression. In: McDowell I, Newell C, eds. Measuring Health: A Guide to Rating Scales and Questionnaires. 2nd ed. New York, NY: Oxford University Press; 1996:238–86.
Spitzer RL, Kroenke K, Williams JBW. Patient Health Questionnaire Study Group. Validity and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282:1737–44.
Spitzer RL, Williams JBW, Kroenke K, et al. Validity and utility of the Patient Health Questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol. 2000;183:759–69.
Stewart AL, Hays RD, Ware JE. The MOS Short Form General Health Survey: reliability and validity in a patient population. Med Care. 1988;26:724–32.
Spitzer RL, Williams JBW, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID). Arch Gen Psychiatry. 1992;49:624–9.
Spitzer RL, Williams JBW, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272:1749–56.
Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2nd ed. Boston, MA: Little, Brown and Company; 1991:1–441.
Murphy JM, Berwick DM, Weinstein MC, et al. Performance of screening and diagnostic tests: application of receiver operating characteristic analysis. Arch Gen Psychiatry. 1987;44:550–5.
Pasacreta JV. Measuring depression. In: Frank-Stromborg M, Olsen SJ, eds. Instruments for Clinical Health-Care Research. 2nd Ed. Sudbury, MA: Jones and Bartlett Publishers; 1997:342–630.
Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27:S178–89.
Berwick DM, Murphy JM, Goldman PA, Ware JE, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29:169–76.
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–9.
Davidson J, Turnbull CD, Strickland R, et al. The Montgomery-Asberg Depression Scale: reliability and validity. Acta Psychiatr Scand. 1986;73:544–8.
Lambert MJ, Hatch DR, Kingston MD, et al. Zung, Beck, and Hamilton rating scales as measures of treatment outcome: a meta-analytic comparison. J Consult Clin Psychol. 1986;54:54–9.
Katon W, Robinson P, Von Korff M, et al. A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry. 1996;53:924–32.
Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines: impact on depression in primary care. JAMA. 1995;273:1026–31.
Williams JW, Barrett J, Oxman T, et al. Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. JAMA. 2000;284:1519–26.
Kroenke K, Taylor-Vaisey A, Dietrich AJ, Oxman TE. Interventions to improve provider diagnosis and treatment of mental disorders in primary care: a critical review of the literature. Psychosomatics. 2000;41:39–52.
Simon GE. Can depression be managed appropriately in primary care? J Clin Psychiatry. 1998;59(suppl 2):3–8.
Hunkeler EM, Meresman J, Hargreaves WA, et al. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med. 2000;9:700–8.
Kobak KA, Taylor LH, Dottl SL, et al. A computer-administered telephone interview to identify mental disorders. JAMA. 1997;278:905–10.
Williams JW, Mulrow CD, Kroenke K, et al. Case-finding for depression improves patient outcomes: results from a randomized trial in primary care. Am J Med. 1999;106:36–43.