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Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa.

ABSTRACT: Depression is often underdiagnosed and undertreated in primary care settings, particularly in developing countries. This is, in part, due to challenges resulting from lack of skilled mental health workers, stigma associated with mental illness, and lack of cross-culturally validated screening instruments. We conducted this study to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) as a screen for diagnosing major depressive disorder among adults in Ethiopia, the second most populous country in sub-Saharan Africa. A total of 926 adults attending outpatient departments in a major referral hospital in Ethiopia participated in this study. We assessed criterion validity and performance characteristics against an independent, blinded, and psychiatrist administered semi-structured Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. Overall, the PHQ-9 items showed good internal (Cronbach's alpha=0.81) and test re-test reliability (intraclass correlation coefficient=0.92). A factor analysis confirmed a one-factor structure. Receiver Operating Characteristics (ROC) analysis showed that a PHQ-9 threshold score of 10 offered optimal discriminatory power with respect to diagnosis of major depressive disorder via the clinical interview (sensitivity=86% and specificity=67%). The PHQ-9 appears to be a reliable and valid instrument that may be used to diagnose major depressive disorders among Ethiopian adults.

SUBMITTER: Gelaye B

PROVIDER: S-EPMC3818385 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa.

Gelaye Bizu B Williams Michelle A MA Lemma Seblewengel S Deyessa Negussie N Bahretibeb Yonas Y Shibre Teshome T Wondimagegn Dawit D Lemenhe Asnake A Fann Jesse R JR Vander Stoep Ann A Andrew Zhou Xiao-Hua XH

Psychiatry research 20130822 2

Depression is often underdiagnosed and undertreated in primary care settings, particularly in developing countries. This is, in part, due to challenges resulting from lack of skilled mental health workers, stigma associated with mental illness, and lack of cross-culturally validated screening instruments. We conducted this study to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) as a screen for diagnosing major depressive disorder among adults in Ethiopia, the ...[more]

PMID: 23972787

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Project description:In Uganda, depression is a major public health issue because of its direct disease burden and as a risk factor and co-morbidity for other pervasive health issues. Psychometric assessment of translated depression measures is critical to public health planning to ensure proper screening, surveillance, and treatment of depression and related outcomes. We examined aspects of the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) translated into Luganda and Runyoro in a large population-based cohort of Ugandan adolescents and adults. Data from the ongoing open cohort AMBSO Population Health Surveillance study were analyzed from the Wakiso and Hoima districts in Uganda. Descriptive statistics were calculated for the overall sample and stratified by translated language. Construct validity was assessed for each translated scale using confirmatory factor analysis for ordinal data. The internal consistency of each translated scale was assessed using Cronbach's alpha, McDonald's omega total and omega hierarchical. Compared to the Runyoro-speaking subsample from Hoima (n=2297), participants in the Luganda-speaking subsample from Wakiso (n=672) were older (27 vs 21 years, p < 0.01) and a greater proportion were female (62% vs. 55%, p < 0.01). The Luganda-translated PHQ-9 had a sample mean of 3.46 (SD=3.26), supported a single-factor structure (RMSEA=0.05, CFI=0.96, TLI=0.94), and demonstrated satisfactory internal consistency (Cronbach's alpha=0.73, McDonald's omega total=0.76, McDonald's omega hierarchical=0.53). The Runyoro-translated PHQ-9 had a comparable sample mean of 3.58 (SD=3.00), also supported a one-factor structure (RMSEA=0.08, CFI=0.92, TLI=0.90), and demonstrated satisfactory internal consistency (Cronbach's alpha=0.72, McDonald's omega total=0.76, McDonald's omega hierarchical=0.57). Our preliminary findings indicate that the Luganda and Runyoro translations of the PHQ-9 had satisfactory construct validity and internal consistency in our sample of Ugandan adolescents and adults. Future studies should expand on this promising work by assessing additional psychometric characteristics of these translated measures in other communities in Uganda.

Project description:BackgroundPatients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda.MethodPHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ?15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs.ResultsFour hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (?5) for mild and moderate depression and ?7 for severe depression.ConclusionPHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ?5 for mild or moderate and ?7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.

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Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa.

Publications

Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa.

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