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Characteristics No. % Age, average (range), y 49 (17–99) – Sex Female 1,611 61.0 Male 1,031 39.0 Ethnicity European 1,881 71.0 Maori 191 7.2 Pacific Island 125 4.7 Chinese 33 1.3 Indian 43 1.6 Other 355 13.4 Unknown 14 0.5 Marital status Single 623 23.6 Married 1,372 51.9 Partnership, civil union 276 10.4 Divorced 159 6.0 Widowed 205 7.8 Unknown 7 0.3 PHQ-2 score ≥1 1,150 44.0 ≥2 679 26.0 ≥3 298 11.3 PHQ-9 score ≥10 341 13.0 ≥15 137 5.2 ≥19 57 2.2 Threshold Score for PHQ-2 Sensitivity Specificity LR+ LR− PPVa % PTL−b % CIDI=Composite International Diagnostic Interview; LR+=positive likelihood ratio; PHQ-2=2-item Patient Health Questionnaire; PPV = positive predictive value; PTL– = posttest likelihood of a negative test. a Posttest likelihood of a positive text. b 1 – Negative predictive value. ≥1 0.96 (156/163) 0.60 (1,485/2,479) 2.4 0.07 14 0.5 ≥2 0.86 (140/163) 0.78 (1,940/2,479) 4.0 0.18 21 1.2 ≥3 0.61 (100/163) 0.92 (2,281/2,479) 7.7 0.42 34 2.7 ≥4 0.40 (66/163) 0.96 (2,388/2,479) 11.0 0.62 42 3.9 Threshold Score for PHQ-9 Sensitivity Specificity LR+ LR− PTL+a % PTL−b % LR+=positive likelihood ratio; LR−=negative likelihood ratio; PTL+ = posttest likelihood of a positive test; PTL+ = posttest likelihood of a negative test; PHQ-9 = 9-item Patient Health Questionnaire. a Positive predictive value. b 1 – Negative predictive value. c The original scoring system created by Spitzer et al in 19996 requires a score of 2 or higher on at least 1 of the first 2 questions and then a minimum score of 2 or higher on 5 of the questions for a diagnosis of PHQ major depression. ≥8 0.82 (134/163) 0.85 (2,111/2,479 5.8 0.16 27 1.0 ≥10 0.74(121/163) 0.91 (2,259/2,479) 8.4 0.28 36 1.8 ≥12 0.61(100/163) 0.94 (2,336/2,479) 10.6 0.44 41 2.6 ≥15 0.45 (73/163) 0.97 (2,415/2,479) 17.3 0.57 53 3.6 PHQ major depression8, c 0.45 (73/163) 0.97 (2,405/2,479) 15.0 0.57 50 3.6 Screening Strategy Depressed by CIDI Diagnosis Patients Requiring PHQ-9 % CIDI = Composite International Diagnostic Interview; PHQ-2 = 2-item Patient Health Questionnaire; PHQ-9 = 9-item Patient Health Questionnaire. a χ2, P <.001. If PHQ-2 score ≥2, complete the PHQ-9 140 26.0 If PHQ-2 score ≥3, complete the PHQ-9 100 11.3 PHQ-9 score ≥10 on all patients 121a 100.0 PHQ-9 score major depression8 73a 100.0
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The Article in Brief
Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
Bruce Arroll , and colleagues
Background The goal of this study was to validate the 2- and 9-question Patient Health Questionnaires, which have been recommended for depression screening in primary care.
What This Study Found The sensitivity and specificity of the PHQ-2 for diagnosing major depression were 86 percent and 78 percent, respectively, with a score of two or higher, and 61 percent and 92 percent with a score of three or higher. For the longer PHQ-9, the sensitivity and specificity were 74 percent and 91 percent, respectively, with a score of 10 or higher. For the PHQ-2, a score of two or higher detected more cases of depression than a score of three or higher. A PHQ-9 score of 10 or higher appeared to detect more depressed patients than the originally described PHQ-9 scoring for major depression.
Implications
- The PHQ-2 can be a useful and time-saving tool for primary care physicians in screening for depression.
- The authors call for a reevaluation of the original PHQ-9 criteria for major depression, as the simple additive score of 10 or higher identified more depressed patients than the original and more onerous method for scoring the questionnaire.
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