TY - JOUR
T1 - Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care
T2 - Journal of Affective Disorders
AU - van der Zwaan, G. L.
AU - van Dijk, S. E. M.
AU - Adriaanse, M. C.
AU - van Marwijk, H. W. J.
AU - van Tulder, M. W.
AU - Pols, A. D.
AU - Bosmans, Judith E.
N1 - ISI Document Delivery No.: CY5QT Times Cited: 4 Cited Reference Count: 38 van der Zwaan, G. Lennart van Dijk, Susan E. M. Adriaanse, Marcel C. van Marwijk, Harm W. J. van Tulder, Maurits W. Pols, Alide D. Bosmans, Judith E. van Tulder, Maurits/0000-0002-7589-8471 ZonMw, the Netherlands Organisation for Health Research and Development [80-82310-97-12110] Funding by ZonMw, the Netherlands Organisation for Health Research and Development (project number 80-82310-97-12110) was obtained. ZonMw did not have any role in the study design, the collection-, analyses- and interpretation of the data, writing of the report or the decision to submit this report for publication. 4 3 7 ELSEVIER SCIENCE BV AMSTERDAM J AFFECT DISORDERS
PY - 2016/1/15
Y1 - 2016/1/15
N2 - Background: Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. Methods: In this cross-sectional study, 586 consecutive DM2/CHD patients aged > 18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. Results: For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. Limitations: Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. Conclusions: The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression. (C) 2015 Elsevier B.V. All rights reserved.
AB - Background: Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. Methods: In this cross-sectional study, 586 consecutive DM2/CHD patients aged > 18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. Results: For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. Limitations: Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. Conclusions: The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression. (C) 2015 Elsevier B.V. All rights reserved.
KW - Coronary heart disease
KW - Depression
KW - Diagnostic accuracy
KW - Mini International Neuropsychiatric Interview
KW - Patient Health Questionnaire-9
KW - Type 2 diabetes
U2 - https://doi.org/10.1016/j.jad.2015.09.045
DO - https://doi.org/10.1016/j.jad.2015.09.045
M3 - Article
C2 - 26480213
SN - 0165-0327
VL - 190
SP - 68
EP - 74
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -