Lower PHQ-9 cutpoint accurately diagnosed depression in people with long-term conditions attending the Accident and Emergency Department

Thomas Hyphantis, Konstantinos Kotsis, Kurt Kroenke, Vassiliki Paika, Stavros Constantopoulos, Alexandros A. Drosos, Andre F. Carvalho, Elspeth Guthrie

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Major Depressive Disorder (MDD) is frequent in the Accident and Emergency Department (AED) but is often unrecognized. We aimed to assess the prevalence of MDD and determine the psychometric properties of the PHQ-9 in diagnosing MDD in patients with long-term medical conditions attending an AED. Methods The PHQ-9 was administered to 349 patients with diabetes, COPD and chronic inflammatory rheumatic diseases, mainly rheumatoid arthritis and spondyloarthropathies, visiting an AED. The MINI interview was used as the criterion standard for MDD. Receiver operator characteristic (ROC) curve analysis was performed to determine the optimal PHQ-9 cutpoint for MDD. Construct validators included psychological distress (SCL-90-R), illness perceptions (B-IPQ) and Health-Related Quality of Life (WHOQOL-BREF). Results The prevalence of MDD was 27.2%. At an optimal cutpoint of 8, PHQ-9 had a sensitivity of 90.5% and specificity of 89.4%. The area under the curve (0.96) was excellent. Convergent validity was established by the strong associations between PHQ-9 scores and functional status, SCL-90-R depression, illness perceptions and AED visits during the previous year. Limitations The sample consisted of multiple rather a single disease group, preventing us from accounting for illness severity using specific disease severity indices. Conclusion MDD is frequent in patients with long-term medical conditions attending the AED and the PHQ-9, at a cutpoint of 8, is an accurate, reliable and valid measure for MDD screening in this patient population.

Original languageEnglish (US)
Pages (from-to)155-163
Number of pages9
JournalJournal of Affective Disorders
Volume176
DOIs
StatePublished - May 1 2015

Fingerprint

Major Depressive Disorder
Hospital Emergency Service
Depression
Spondylarthropathies
Rheumatic Diseases
Psychometrics
Chronic Obstructive Pulmonary Disease
Area Under Curve
Rheumatoid Arthritis
Quality of Life
Interviews
Psychology
Sensitivity and Specificity
Population

Keywords

  • COPD
  • Depression
  • Diabetes
  • Emergency Department
  • Screening

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology
  • Medicine(all)

Cite this

Lower PHQ-9 cutpoint accurately diagnosed depression in people with long-term conditions attending the Accident and Emergency Department. / Hyphantis, Thomas; Kotsis, Konstantinos; Kroenke, Kurt; Paika, Vassiliki; Constantopoulos, Stavros; Drosos, Alexandros A.; Carvalho, Andre F.; Guthrie, Elspeth.

In: Journal of Affective Disorders, Vol. 176, 01.05.2015, p. 155-163.

Research output: Contribution to journalArticle

Hyphantis, Thomas ; Kotsis, Konstantinos ; Kroenke, Kurt ; Paika, Vassiliki ; Constantopoulos, Stavros ; Drosos, Alexandros A. ; Carvalho, Andre F. ; Guthrie, Elspeth. / Lower PHQ-9 cutpoint accurately diagnosed depression in people with long-term conditions attending the Accident and Emergency Department. In: Journal of Affective Disorders. 2015 ; Vol. 176. pp. 155-163.
@article{540486db225b4b70bb056cab2cbd1313,
title = "Lower PHQ-9 cutpoint accurately diagnosed depression in people with long-term conditions attending the Accident and Emergency Department",
abstract = "Background Major Depressive Disorder (MDD) is frequent in the Accident and Emergency Department (AED) but is often unrecognized. We aimed to assess the prevalence of MDD and determine the psychometric properties of the PHQ-9 in diagnosing MDD in patients with long-term medical conditions attending an AED. Methods The PHQ-9 was administered to 349 patients with diabetes, COPD and chronic inflammatory rheumatic diseases, mainly rheumatoid arthritis and spondyloarthropathies, visiting an AED. The MINI interview was used as the criterion standard for MDD. Receiver operator characteristic (ROC) curve analysis was performed to determine the optimal PHQ-9 cutpoint for MDD. Construct validators included psychological distress (SCL-90-R), illness perceptions (B-IPQ) and Health-Related Quality of Life (WHOQOL-BREF). Results The prevalence of MDD was 27.2{\%}. At an optimal cutpoint of 8, PHQ-9 had a sensitivity of 90.5{\%} and specificity of 89.4{\%}. The area under the curve (0.96) was excellent. Convergent validity was established by the strong associations between PHQ-9 scores and functional status, SCL-90-R depression, illness perceptions and AED visits during the previous year. Limitations The sample consisted of multiple rather a single disease group, preventing us from accounting for illness severity using specific disease severity indices. Conclusion MDD is frequent in patients with long-term medical conditions attending the AED and the PHQ-9, at a cutpoint of 8, is an accurate, reliable and valid measure for MDD screening in this patient population.",
keywords = "COPD, Depression, Diabetes, Emergency Department, Screening",
author = "Thomas Hyphantis and Konstantinos Kotsis and Kurt Kroenke and Vassiliki Paika and Stavros Constantopoulos and Drosos, {Alexandros A.} and Carvalho, {Andre F.} and Elspeth Guthrie",
year = "2015",
month = "5",
day = "1",
doi = "10.1016/j.jad.2015.01.062",
language = "English (US)",
volume = "176",
pages = "155--163",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",

}

TY - JOUR

T1 - Lower PHQ-9 cutpoint accurately diagnosed depression in people with long-term conditions attending the Accident and Emergency Department

AU - Hyphantis, Thomas

AU - Kotsis, Konstantinos

AU - Kroenke, Kurt

AU - Paika, Vassiliki

AU - Constantopoulos, Stavros

AU - Drosos, Alexandros A.

AU - Carvalho, Andre F.

AU - Guthrie, Elspeth

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background Major Depressive Disorder (MDD) is frequent in the Accident and Emergency Department (AED) but is often unrecognized. We aimed to assess the prevalence of MDD and determine the psychometric properties of the PHQ-9 in diagnosing MDD in patients with long-term medical conditions attending an AED. Methods The PHQ-9 was administered to 349 patients with diabetes, COPD and chronic inflammatory rheumatic diseases, mainly rheumatoid arthritis and spondyloarthropathies, visiting an AED. The MINI interview was used as the criterion standard for MDD. Receiver operator characteristic (ROC) curve analysis was performed to determine the optimal PHQ-9 cutpoint for MDD. Construct validators included psychological distress (SCL-90-R), illness perceptions (B-IPQ) and Health-Related Quality of Life (WHOQOL-BREF). Results The prevalence of MDD was 27.2%. At an optimal cutpoint of 8, PHQ-9 had a sensitivity of 90.5% and specificity of 89.4%. The area under the curve (0.96) was excellent. Convergent validity was established by the strong associations between PHQ-9 scores and functional status, SCL-90-R depression, illness perceptions and AED visits during the previous year. Limitations The sample consisted of multiple rather a single disease group, preventing us from accounting for illness severity using specific disease severity indices. Conclusion MDD is frequent in patients with long-term medical conditions attending the AED and the PHQ-9, at a cutpoint of 8, is an accurate, reliable and valid measure for MDD screening in this patient population.

AB - Background Major Depressive Disorder (MDD) is frequent in the Accident and Emergency Department (AED) but is often unrecognized. We aimed to assess the prevalence of MDD and determine the psychometric properties of the PHQ-9 in diagnosing MDD in patients with long-term medical conditions attending an AED. Methods The PHQ-9 was administered to 349 patients with diabetes, COPD and chronic inflammatory rheumatic diseases, mainly rheumatoid arthritis and spondyloarthropathies, visiting an AED. The MINI interview was used as the criterion standard for MDD. Receiver operator characteristic (ROC) curve analysis was performed to determine the optimal PHQ-9 cutpoint for MDD. Construct validators included psychological distress (SCL-90-R), illness perceptions (B-IPQ) and Health-Related Quality of Life (WHOQOL-BREF). Results The prevalence of MDD was 27.2%. At an optimal cutpoint of 8, PHQ-9 had a sensitivity of 90.5% and specificity of 89.4%. The area under the curve (0.96) was excellent. Convergent validity was established by the strong associations between PHQ-9 scores and functional status, SCL-90-R depression, illness perceptions and AED visits during the previous year. Limitations The sample consisted of multiple rather a single disease group, preventing us from accounting for illness severity using specific disease severity indices. Conclusion MDD is frequent in patients with long-term medical conditions attending the AED and the PHQ-9, at a cutpoint of 8, is an accurate, reliable and valid measure for MDD screening in this patient population.

KW - COPD

KW - Depression

KW - Diabetes

KW - Emergency Department

KW - Screening

UR - http://www.scopus.com/inward/record.url?scp=84923354840&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923354840&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2015.01.062

DO - 10.1016/j.jad.2015.01.062

M3 - Article

VL - 176

SP - 155

EP - 163

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -