Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya

Patrick Monahan, Enbal Shacham, Michael Reece, Kurt Kroenke, Willis Owino Ong'Or, Otieno Omollo, Violet Naanyu Yebei, Claris Ojwang

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

Depression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings. To assess the validity/reliability of PHQ-9 and PHQ-2. Observational, two occasions 7 days apart. A total of 347 patients attending psychosocial support groups. Demographics, PHQ-9, PHQ-2, general health perception rating and CD4 count. Rates for PHQ-9 DSM-IV major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder were 13%, 21% and 34%. Depression was associated with female gender, but not CD4. Construct validity was supported by: (1) a strong association between PHQ-9 and general health rating, (2) a single major factor with loadings exceeding 0.50, (3) item-total correlations exceeding 0.37 and (4) a pattern of item means similar to US validation studies. Four focus groups indicated culturally relevant content validity and minor modifications to the PHQ-9 instructions. Coefficient alpha was 0.78. Test-retest reliability was acceptable: (1) intraclass correlation 0.59 for PHQ-9 total score, (2) kappas 0.24, 0.25 and 0.38 for PHQ-9 MDD, ODD and any depressive disorder and (3) weighted kappa 0.53 for PHQ-9 depression severity categories. PHQ-2 3 demonstrated high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively, for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18-35, 36-61) subgroups. PHQ-9 and PHQ-2 appear valid/reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in western Kenya.

Original languageEnglish
Pages (from-to)189-197
Number of pages9
JournalJournal of General Internal Medicine
Volume24
Issue number2
DOIs
StatePublished - Feb 2009

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Kenya
Reproducibility of Results
Acquired Immunodeficiency Syndrome
HIV
Depression
Health
Depressive Disorder
Major Depressive Disorder
Diagnostic and Statistical Manual of Mental Disorders
Surveys and Questionnaires
Area Under Curve
Africa South of the Sahara
Self-Help Groups
Validation Studies
CD4 Lymphocyte Count
Focus Groups
Psychometrics

Keywords

  • Africa
  • Depression
  • HIV/AIDS
  • Kenya
  • PHQ-9

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya. / Monahan, Patrick; Shacham, Enbal; Reece, Michael; Kroenke, Kurt; Ong'Or, Willis Owino; Omollo, Otieno; Yebei, Violet Naanyu; Ojwang, Claris.

In: Journal of General Internal Medicine, Vol. 24, No. 2, 02.2009, p. 189-197.

Research output: Contribution to journalArticle

Monahan, Patrick ; Shacham, Enbal ; Reece, Michael ; Kroenke, Kurt ; Ong'Or, Willis Owino ; Omollo, Otieno ; Yebei, Violet Naanyu ; Ojwang, Claris. / Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya. In: Journal of General Internal Medicine. 2009 ; Vol. 24, No. 2. pp. 189-197.
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