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Research ArticleMethodology

Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population

Bruce Arroll, Felicity Goodyear-Smith, Susan Crengle, Jane Gunn, Ngaire Kerse, Tana Fishman, Karen Falloon and Simon Hatcher
The Annals of Family Medicine July 2010, 8 (4) 348-353; DOI: https://doi.org/10.1370/afm.1139
Bruce Arroll
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Felicity Goodyear-Smith
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Susan Crengle
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Jane Gunn
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Ngaire Kerse
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Tana Fishman
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Karen Falloon
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Simon Hatcher
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  • We agree with Prof Schulberg and go further electronically
    Bruce Arroll
    Published on: 05 October 2010
  • The PHQ-2, PHQ-9, and Screening for Psychiatric Illnesses
    Herbert C Schulberg
    Published on: 17 August 2010
  • Screening simple enough to be routine
    Daniel C Vinson
    Published on: 22 July 2010
  • Published on: (5 October 2010)
    Page navigation anchor for We agree with Prof Schulberg and go further electronically
    We agree with Prof Schulberg and go further electronically
    • Bruce Arroll, New Zealand
    • Other Contributors:

    We are delighted to receive a comment on our paper from Professor Schulberg. We agree with his point of screening for multiple conditions rather than single conditions. Our publication of the validity of the PHQ- 2 and PHQ-9 was an academic work but our heart is in multi-item screening tools. We have used the CHAT (ref 1) to screen for ten items including smoking, alcohol, drugs, gambling, depression, anxiety, anger, vio...

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    We are delighted to receive a comment on our paper from Professor Schulberg. We agree with his point of screening for multiple conditions rather than single conditions. Our publication of the validity of the PHQ- 2 and PHQ-9 was an academic work but our heart is in multi-item screening tools. We have used the CHAT (ref 1) to screen for ten items including smoking, alcohol, drugs, gambling, depression, anxiety, anger, violence, stress and physical activity. It has been used in a paper version and then scanned in to the electronic health record (EHR) and we now have (in beta version) an Ipad version (touch screen) which patients will use from the waiting room and which will arrive on the clinicians computer via the internet. The final step will be to develop a touch screen in the waiting room which will arrive in the clinicians computer and be embedded in the correct locations. We have found this substantially changes the consulation. eg if a patient presents with a headace and severe depression and anxiety we will not spend a lot of time looking for the brain tumor but get on with the issue of treating the anxiety and the depression. It will hopefully increase the interest in mental health issues among primary care clinicians.

    1. GOODYEAR-SMITH, F.A., ARROLL, B., COUPE, N.M. 'Asking for help is helpful: validation of a brief lifestyle and mood assessment tool in primary health care.', Ann Fam Med, 2009 7: 239-244

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (17 August 2010)
    Page navigation anchor for The PHQ-2, PHQ-9, and Screening for Psychiatric Illnesses
    The PHQ-2, PHQ-9, and Screening for Psychiatric Illnesses
    • Herbert C Schulberg, White Plains, USA
    • Other Contributors:

    Inducing physicians to administer screening instruments for psychiatric illnesses is a complex undertaking. The initial step is to convince physicians that a screening instrument is psychometrically valid. Arroll and colleagues are to be commended, therefore, for generating data needed to inform primary care physicians about the psychometric strengths as well as limitations of the PHQ-2 and PHQ-9. While the data present...

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    Inducing physicians to administer screening instruments for psychiatric illnesses is a complex undertaking. The initial step is to convince physicians that a screening instrument is psychometrically valid. Arroll and colleagues are to be commended, therefore, for generating data needed to inform primary care physicians about the psychometric strengths as well as limitations of the PHQ-2 and PHQ-9. While the data presented by Arroll, et al. regarding the sensitivity, specificity, and other properties of these instruments in primary care practice surely are meaningful, we must also emphasize the need to ascertain the psychometric properties of these instruments when administered elsewhere. Thus, Arroll, et al. note that the PHQ-9’s sensitivity diminishes markedly when administered in cardiology clinics. This possibly results from the distress associated with certain medical illnesses and functional limitations that compromise the ability of screening instruments to correctly detect depression. Rollman, et al. (1), however, report a significantly higher all-cause 12-month mortality rate for hospitalized congestive heart failure patients who screened positive on the PHQ-2. We also question the clinical utility of administering only diagnosis- specific screening instruments, given the high prevalence of co-occurring psychiatric illnesses in primary care practice. Thus, the M-3 (2) which screens for major depression with the same sensitivity and specificity as the PHQ-9, as determined by Arroll, et al., but which also screens for bipolar disorder, PTSD, and generalized anxiety warrants greater attention as we strive to improve the identification of ALL psychiatric illnesses troubling medical patients.

    1. Rollman B, Herbeck-Belnap B, Mazumdar S, et al. A positive PHQ-2 depression screen among hospitalized CHF patients predicts 12-month mortality. Psychosom Med 2010; suppl: A141.

    2. Gaynes B, DeVeaugh-Geiss J, Weir S, et al. Feasibility and diagnostic validity of the M-3 Checklist: A brief, self-rated screen for depressive, bipolar, anxiety, and pos-traumatic stress disorders in primary care. Ann Fam Med 2010: 8; 160-169.

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (22 July 2010)
    Page navigation anchor for Screening simple enough to be routine
    Screening simple enough to be routine
    • Daniel C Vinson, Columbia, MO

    Dr. Arroll and his colleagues have given us a well-crafted and well- conducted study that validates the PHQ-2 and 9, underscoring their utility in primary care. Distilling screening for a disease as complex as depression down to just two questions by Spitzer and colleagues has now been additionally and independently validated in primary care.

    The challenge remains for us to integrate the simple PHQ-2 questions in...

    Show More

    Dr. Arroll and his colleagues have given us a well-crafted and well- conducted study that validates the PHQ-2 and 9, underscoring their utility in primary care. Distilling screening for a disease as complex as depression down to just two questions by Spitzer and colleagues has now been additionally and independently validated in primary care.

    The challenge remains for us to integrate the simple PHQ-2 questions into our conversations with patients, follow up with empathic inquiry, and address the issues identified. Systems of care need to change to provide the team-based, integrated care patients with depression (and many other chronic illnesses) need. But this study makes it clear. We have a screening test that, despite its limitations, is ready for us to use.

    Thanks for a well-done study!

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
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The Annals of Family Medicine: 8 (4)
The Annals of Family Medicine: 8 (4)
Vol. 8, Issue 4
1 Jul 2010
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Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
Bruce Arroll, Felicity Goodyear-Smith, Susan Crengle, Jane Gunn, Ngaire Kerse, Tana Fishman, Karen Falloon, Simon Hatcher
The Annals of Family Medicine Jul 2010, 8 (4) 348-353; DOI: 10.1370/afm.1139

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Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
Bruce Arroll, Felicity Goodyear-Smith, Susan Crengle, Jane Gunn, Ngaire Kerse, Tana Fishman, Karen Falloon, Simon Hatcher
The Annals of Family Medicine Jul 2010, 8 (4) 348-353; DOI: 10.1370/afm.1139
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