Concordance between the PHQ-9 and the HSCL-20 in depressed primary care patients

Pamela W. Lee, Herbert C. Schulberg, Patrick J. Raue, Kurt Kroenke

Research output: Contribution to journalArticle

52 Scopus citations


Background: Two instruments commonly used in primary care research to measure depressive severity are the Patient Health Questionnaire-9 (PHQ-9) and the Hopkins Symptom Checklist-20 (HSCL-20). However, there is little information regarding the relationship between clinical information derived from these scales. The present study investigates the psychometric properties of the PHQ-9 and HSCL-20, determines the degree of instrument concordance, and describes the factor structure of the HSCL-20. Methods: A secondary data analysis from a randomized controlled trial was performed. A total of 405 primary care patients with major depressive disorder and/or dysthymia were administered the PHQ-9 and the HSCL-20 when recruited for the study. Results: Good internal consistency reliability estimates were obtained for both scales (PHQ-9 α = 0.803; HSCL-20 α = 0.837). All PHQ-9 inter-item and corrected item-total correlations showed that no item detracted from overall scale functioning. HSCL-20 items assessing overeating, poor appetite, and sexual interest were poorly correlated with other items and with the total scale score. A positive, moderate strength relationship was found between the instruments (r = 0.54, p < 0.0001). Exploratory factor analysis of the HSCL-20 yielded a six-factor structure, which accounted for almost 63% of the variance in total score. The largest contribution to common variance in the scale was provided by an "anxiety and self-reproach" factor. Conclusions: PHQ-9 and HSCL-20 total scores were moderately correlated. Although the HSCL-20 is utilized as a measure of depression severity, it may lack sufficient specificity to be an accurate reflection of depression status per se.

Original languageEnglish (US)
Pages (from-to)139-145
Number of pages7
JournalJournal of Affective Disorders
Issue number1-3
StatePublished - Apr 1 2007


  • Assessment
  • Depression
  • Primary care
  • Psychometrics

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Behavioral Neuroscience
  • Biological Psychiatry
  • Neurology
  • Psychology(all)

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