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. 2010 Aug 12:10:235.
doi: 10.1186/1472-6963-10-235.

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

Kirsten M van Steenbergen-Weijenburg  1 , Lars de Vroege, Robert R Ploeger, Jan W Brals, Martijn G Vloedbeld, Thiemo F Veneman, Leona Hakkaart-van Roijen, Frans F J Rutten, Aartjan T F Beekman, Christina M van der Feltz-Cornelis
Affiliations

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

Kirsten M van Steenbergen-Weijenburg et al. BMC Health Serv Res. .

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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Figures

Figure 1
Figure 1
ROC curve for PHQ-9 vs. MINI and Algorithm vs. MINI. (Note: the dotted line is the reference line)
See this image and copyright information in PMC

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