Patient Health Questionnaire

BackgroundZung's Self-rating Anxiety Scale (SAS) is a norm-referenced scale which enjoys widespread use a screener for anxiety disorders. However, recent research (Dunstan DA and Scott N, Depress Res Treat 2018:9250972, 2018) has questioned whether the existing cut-off for identifying the presence of a disorder might be lower than ideal.MethodThe current study explored this issue by examining sensitivity and specificity figures against diagnoses made on the basis of the Patient Health Questionnaire (PHQ) in clinical and community samples. The community sample consisted of 210 participants recruited to be representative of the Australian adult population. The clinical sample consisted of a further 141 adults receiving treatment from a mental health professional for some form of anxiety disorder.ResultsMathematical formulas, including Youden's Index and the Receiver Operating Characteristics Curve, applied to positive PHQ diagnoses (presence of a disorder) from the clinical sample and negative PHQ diagnoses (absence of a disorder) from the community sample suggested that the ideal cut-off point lies between the current and original points recommended by Zung.ConclusionsConsideration of prevalence rates and of the potential costs of false negative and false positive diagnoses, suggests that, while the current cut-off of 36 might be appropriate in the context of clinical screening, the original raw score cut-off of 40 would be most appropriate when the SAS is used in research.

BackgroundTo assess the reliability and validity of Patient Health Questionnaire-9 (PHQ-9) for patients with major depressive disorder (MDD) and to assess the feasibility of its use in psychiatric hospitals in China.MethodsOne hundred nine outpatients or inpatients with MDD who qualified the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria completed PHQ-9 and Hamilton Depression Scale (HAMD-17). Two weeks after the initial evaluation, 54 randomly selected patients underwent repeat assessment using PHQ-9. For validity analysis, the construct validity and criterion validity were assessed. The internal concordance coefficient and the test-retest correlation coefficients were used for reliability analysis. The correlation between total score and scores for each item and the correlation between scores for various items were evaluated using Pearson correlation coefficient.ResultsPrincipal components factor analysis showed good construct validity of the PHQ-9. PHQ-9 total score showed a positive correlation with HAMD-17 total score (r = 0.610, P ConclusionsPHQ-9 showed good reliability and validity, and high adaptability for patients with MDD in psychiatric hospital. It is a simple, rapid, effective, and reliable tool for screening and evaluation of the severity of depression.

BackgroundZung's Self-rating Depression Scale (SDS) is an established norm-referenced screening measure used to identify the presence of depressive disorders in adults. Despite widespread usage, issues exist concerning the recommended cut-off score for a positive diagnosis. First, confusion arising from the conversion of raw scores to index scores had resulted in a considerably higher cut-off score than that recommended being used by many researchers. Second, research in China [Chin J Nervous Mental Dis. 12:267-268; 2009] and Australia [BMC Psychiatry. 17:329; 2017] had suggested that the current recommended cut-off is lower than ideal, at least in those countries.MethodTo explore these matters further, sensitivity and specificity figures for alternative cut-off points were examined in positive clinical and negative community samples respectively. The positive clinical sample (n = 57) consisted of adults receiving treatment from a medical professional for some kind of depressive disorder, whose diagnosis was positively confirmed using the Patient Health Questionnaire (PHQ). The negative community sample (n = 172) was derived from a representative sample of adults whose absence of any depressive disorder was similarly confirmed by the PHQ.ResultsMathematical models, including Youden's Index and the Receiver Operating Characteristics Curve, suggest that the recommended cut-off (a raw score of 40) is indeed too low. More detailed comparisons, including consideration of the likely numbers of false positives and negatives given prevalence rates, confirm that, ironically, the incorrect SDS cut-off score mistakenly applied by many researchers (a raw score of 50) would appear to provide far greater accuracy.ConclusionsResearch in China [Chin J Nervous Mental Dis. 12:267-268; 2009] has resulted in an elevated SDS cut-off score of 42 being used in many Chinese studies. Research by Dunstan and Scott [BMC Psychiatry. 17:329; 2017] in an Australian context, suggested that a greater increase, to a raw score of 44 might be required. Based on this study, an even larger adjustment is required. Specifically, we recommend the use of an SDS raw score of 50 as the cut-off point for clinical significance.

BACKGROUND: Somatic symptoms are common among trauma-exposed populations and are often associated with persistent distress and functional impairment, highlighting the need for culturally appropriate assessment tools. OBJECTIVE: This study aimed to translate and culturally adapt the Patient Health Questionnaire-15 (PHQ-15), a screening measure of somatic symptom burden, into Central Kurdish and assess its psychometric properties among survivors of chemical gas exposure. METHODS: A total of 534 survivors were recruited through community and registry sources. After translation and cultural adaptation, item 4 and item 11 were removed due to cultural and gender-specific considerations and limited psychometric performance, resulting in a 13-item version. Factor structure was examined using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). Measurement invariance across gender and age groups was evaluated using multi-group CFA. Internal consistency was assessed using McDonald’s omega. An exploratory network analysis (EBICglasso) examined conditional associations among symptoms. RESULTS: Both a unidimensional CFA model (CFI = 0.988, RMSEA = 0.054) and a three-factor ESEM model (CFI = 0.992, RMSEA = 0.046) showed good model fit, with the ESEM structure providing a more differentiated representation of pain/fatigue, gastrointestinal, and cardiopulmonary domains. Measurement invariance testing supported full scalar invariance across gender, while partial metric invariance was observed across age groups. Internal consistency was acceptable (ω = 0.70–0.83). Network estimates demonstrated acceptable stability, with correlation stability coefficients of 0.59 for edge strength and 0.52 for bridge strength, and should be interpreted as exploratory. CONCLUSION: The culturally adapted 13-item Kurdish PHQ demonstrates acceptable reliability and initial evidence of construct validity in trauma-exposed survivors of chemical attacks. The instrument may be used as a screening tool for somatic symptom burden in this context, while further validation in broader Kurdish populations is recommended.