The PHQ-9: Validity of a brief depression severity measure

Kurt Kroenke, R. L. Spitzer, J. B W Williams

Research output: Contribution to journalArticle

11230 Citations (Scopus)

Abstract

OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "O" not at all) to "3" nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

Original languageEnglish
Pages (from-to)606-613
Number of pages8
JournalJournal of General Internal Medicine
Volume16
Issue number9
DOIs
StatePublished - 2001

Fingerprint

Depression
Sick Leave
Gynecology
Obstetrics
Primary Health Care
Patient Acceptance of Health Care
Depressive Disorder
Ambulatory Care
Health Surveys
Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
Mental Health
Interviews
Health
Research
Therapeutics

Keywords

  • Depression
  • Diagnosis
  • Health status
  • Psychological tests
  • Screening

ASJC Scopus subject areas

  • Internal Medicine

Cite this

The PHQ-9 : Validity of a brief depression severity measure. / Kroenke, Kurt; Spitzer, R. L.; Williams, J. B W.

In: Journal of General Internal Medicine, Vol. 16, No. 9, 2001, p. 606-613.

Research output: Contribution to journalArticle

Kroenke, Kurt ; Spitzer, R. L. ; Williams, J. B W. / The PHQ-9 : Validity of a brief depression severity measure. In: Journal of General Internal Medicine. 2001 ; Vol. 16, No. 9. pp. 606-613.
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