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. 2015 May 23:15:118.
doi: 10.1186/s12888-015-0503-0.

The validity of the Patient Health Questionnaire for screening depression in chronic care patients in primary health care in South Africa

Arvin Bhana  1 , Sujit D Rathod  2 , One Selohilwe  3 , Tasneem Kathree  4 , Inge Petersen  5
Affiliations

The validity of the Patient Health Questionnaire for screening depression in chronic care patients in primary health care in South Africa

Arvin Bhana et al. BMC Psychiatry. .

Abstract

Background: People with chronic health conditions are known to have a higher prevalence of depressive disorder. The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression which has not yet been validated for use on chronic care patients in South Africa.

Methods: A sample of 676 chronic care patients attending two primary health facilities in North West Province, South Africa were administered the PHQ-9 by field workers and a diagnostic interview (the Structured Clinical Interview for DSM-IV) (SCID) by clinical psychologists. The PHQ-9 and the PHQ-2 were evaluated against the SCID, as well as for sub-samples of patients who were being treated for HIV infection and for hypertension.

Results: Using the SCID, 11.4 % of patients had major depressive disorder. The internal consistency estimate for the PHQ-9 was 0.76, with an area under the receiver operator curve (AUROC) of 0.85 (95 % CI 0.82-0.88), which was higher than the AURUC for the PHQ-2 (0.76, 95 % CI 0.73-0.79). Using a cut-point of 9, the PHQ-9 has sensitivity of 51 % and specificity of 94 %. The PHQ-9 AUROC for the sub-samples of patients with HIV and with hypertension were comparable (0.85 and 0.86, respectively).

Conclusions: The PHQ-9 is useful as a screening tool for depression among patients receiving treatment for chronic care in a public health facility.

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Figures

Fig. 1
Fig. 1
Receiver operating characteristic (ROC) curve for PHQ-9
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve for PHQ-2
Fig. 3
Fig. 3
Receiver operating characteristic (ROC) curve comparing PHQ-9 to PHQ-2
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