Sample Measure Critique of PHQ9

Northcentral University                                                                                  MSW-6007

 

Sample Measure Critique

 

 

Critiqued by: KL

 

Date: January 25, 2016

 

Name of measure: PHQ9

 

Developer(s): Kurt Kroenke, Robert L. Spitzer, & Janet B.W. Williams

 

Source reference: https://www.communitycarenc.org/media/related-downloads/depression-toolkit.pdf

 

Construct(s) assessed: Criteria-based diagnosis of depression in individuals seen in primary care and other medical and mental health facilities

 

Method of administration: Nine symptom checklist that can be professionally or self-administered (paper and pencil, electronically, or over the phone).

 

Summary of reliability evidence:

• Internal reliability was excellent, with a Cronbach’s alpha of 0.89 in a Primary Care Study and 0.86 in an OB-Gyn Study (Kroenke, Spitzer, & Williams, 2001).
• Test-retest reliability was very high at a 0.96 in a longitudinal study (Draper et al., 2008).

 

Summary of validity evidence:

In a study done by Kroenke et al. (2001), both criterion and construct validity were established as well as external validity. Construct validity was demonstrated in a sample of 580 primary care patients who underwent an independent re-interview. Criterion validity was shown by the strong association between PHQ-9 scores and functional status disability days and symptoms related difficulty. External validity was achieved by replicating the findings from 3,000 primary care patients in a second sample of 3,000 Ob-gyn patients.

• The PHQ-9 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 sores of 5, 10, 15, 20 fully represented mild, moderate, moderately severe, and severe depression respectively (Kroenke et al., 2001).

 

Summary of clinical use:

The PHQ-9 was founded and used in primary care settings where a nurse, physician or mental health provider has administered the questionnaire. In recent years, it has also been administered in many different types of medical settings and in mental health offices. Administration by telephone and touch-screen has been validated (Fann et al., 2009; Kroenke et al., 2001). Often times it is self administered and the mental health provider or medical health provider can score and determine possible depression and severity at the time administered. It has also been shown to notify mental health providers if therapy/treatment is going well.

 

Recommendations for clinical use:

The PHQ-9 is a tool that can be used for diagnosing depression, depression severity, and gauging response to depression treatment in clinical research (Lowe, Unutzer, Callahan & Kroenke, 2004; Lowe, Unutzer, Callahan, Perkins, & Kroenke, 2004). The PHQ-9 will be of great help in therapy to determine if the patient is responding to therapy/treatment. This particular measure is designed to be used in conjunction with the DSM-5 to provide correct diagnosis and severity level. Since this assessment tool has been used widely throughout different settings and with a diverse population, it will be important to research your population/setting to best reach a correct diagnosis and severity level, especially during therapy.

 

Summary of research use:

• Clinical Interviewing for depression (Fann et al., 2005)
• Determining depression in primary care settings (DeJesus, Vickers, Melin, Williams, 2007; Kroenke et al., 2001)
• Comparisons to other mental health assessments (Draper et al., 2008; Kroenke et al., 2001)
• Determining if the assessment works for other cultures and countries (Huang, Chung, Kroenke, Delucchi & Spitzer, 2006; Yeung et al., 2008 )
• Longitudinal research of depression after traumatic events (Draper et al., 2008)
• Diagnosis and assessment of depression with comorbid disease or medical conditions (Lamers et al., 2008; Fann et al., 2005)
• Ability to predict depression severity and accomplishment of therapy/treatments (Lowe, Unutzer, Callahan, et al., 2004a; Lowe, Unutzer, Callahan, Perkins, et al., 2004b).

 

Populations utilized with:

The population has been utilized and validated with individuals of various cultural backgrounds, countries, languages, medical conditions, marital status, gender, age, regions of the U.S., post-disaster, education status, and economical status. Some examples to name a few are as follows:

• Oncology, using touch screens (Fann et al., 2009)
• Individuals following traumatic brain injury (Fann et al., 2005)
• Primary care patients (DeJesus et al., 2007)
• Those affected by child abuse or gender-based violence (Anastario, Larrance & Lawry, 2008; Draper et al., 2008)
• Used in different countries and in different language versions (Han et al., 2008; Yeung et al., 2008)
• Racially and ethnically diverse population at primary care facilities (African American, Chinese American, Latino, and non-Hispanic white patient groups) (Huang et al., 2006)
• Chronically ill elder patients (Lamers et al., 2008)

 

Example of use in research: (Lamers et al., 2008)

Objective: to assess the psychometric properties of the PHQ-9 as a screening tool for depression in elderly patients with diabetes and chronic obstructive pulmonary disease (COPD) without previously known depression.

 

Method/Design: Diabetes and COPD patients older than 59 years were given PHQ-9. 105 participants were given a test-retest assessment. Participants were also given the Mini International Neuropsychiatric Interview psychiatric interview to diagnose major depressive disorder (MDD) and established Criterion validity. Correlations with quality of life and severity of illness were calculated to assess construct validity.

 

Results: PHQ-9 is a valid and reliable screening instrument for depression in elderly primary care patients with diabetes and COPD

 

Future research needed:

Future research is needed to determine if the PHQ-9 would be used instead of longer, more costly, interviewer-administered outcome measures such as the Hamilton Depression Rating Scale.

 

Overall impression of measure:

The PHQ-9 has well established reliability and validity and can be used with a variety of populations in both medical and non-medical settings. I think it can be a wonderful tool for clinicians with depressed clients to determine if therapy is working.

 

References

 

Anastario, M. P., Larrance, R., & Lawry, L. (2008). Using Mental Health Indicators to Identify   Postdisaster Gender-Based Violence among Women Displaced by Hurricane Katrina.    Journal of Women’s Health, 17(9), 1437-1444.

 

DeJesus, R. S., Vickers, K. S., Melin, G. J., & Williams, M. D. (2007). A System-Based                Approach to Depression Management in Primary Care Using the Patient Health Questionnaire-9. Mayo Clinic Proceedings, 82(11), 1395-1402.

 

Draper, B., Pfaff, J. J., Pirkis, J., Snowdon, J., Lautenschlager, N. T., Wilson, I., et al. (2008).       Long-Term Effects of Childhood Abuse on the Quality of Life and Health of Older     People: Results from the Depression and Early Prevention of Suicide in General Practice       Project. Journal of the American Geriatrics Society, 56(2), 262-271.

 

Fann, J. R., Berry, D. L., Wolpin, S., Austin-Seymour, M., Bush, N., Halpenny, B., et al. (2009). Depression screening using the Patient Health Questionnaire-9 administered on a touch            screen computer. Psycho-Oncology, 18(1), 14-22.

 

Fann, J. R., Bombardier, C. H., Dikmen, S., Esselman, P., Warms, C. A., Pelzer, E., et al. (2005). Validity of the Patient Health Questionnaire-9 in Assessing Depression Following        Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 20(6), 501-511.

 

Han, C., Jo, S. A., Kwak, J. H., Pae, C. U., Steffens, D., Jo, I., et al. (2008). Validation of the                  Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan           Geriatric study. Comprehensive Psychiatry, 49(2), 218-223.

 

Huang, F., Chung, H., Kroenke, K., Delucchi, K., & Spitzer, R. L. (2006). Using the Patient         Health Questionnaire-9 to Measure Depression among Racially and Ethnically Diverse      Primary Care Patients. Journal of General Internal Medicine, 21(6), 547-552.

 

Huang, F. Y., Chung, H., Kroenke, K., Delucchi, K. L., & Spitzer, R. L. (2006). Using the           Patient Health Questionnaire-9 to measure depression among racially and ethnically           diverse primary care patients. Journal of General Internal Medicine, 21(6), 547-552.

 

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. JGIM: Journal of General Internal Medicine, 16(9), 606-613.

 

Laowe, B., Kroenke, K., Herzog, W., & Grafe, K. (2004). Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire            (PHQ-9). Journal of Affective Disorders, 81(1), 61-66.

 

Laowe, B., Unutzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring            depression treatment outcomes with the patient health questionnaire-9. Medical Care, 42(12), 1194-1201.

 

Lamers, F., Jonkers, C. C., Bosma, H., Penninx, B. W., Knottnerus, J. A., & van Eijk, J. T.            (2008). Summed score of the Patient Health Questionnaire-9 was a reliable and valid         method for depression screening in chronically ill elderly patients. Journal Of Clinical        Epidemiology, 61(7), 679-687.

 

Yeung, A., Fung, F., Yu, S. C., Vorono, S., Ly, M., Wu, S., et al. (2008). Validation of the           Patient Health Questionnaire-9 for depression screening among Chinese Americans.           Comprehensive Psychiatry, 49(2), 211-217.

 

 

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