Measuring depressive symptoms using the Patient Health Questionnaire-9 in Hong Kong Chinese subjects with type 2 diabetes

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• 作者：Yuying Zhang ; Rose Ting ; Marco Lam ; Joyce Lam ; Hairong Nan ; Roseanne Yeung ; Wenying Yang ; Linong Ji ; Jianping Weng ; Yun-Kwok Wing ; Norman Sartorius ; Juliana C.N. Chan
• 关键词：Depression ; Type 2 diabetes ; Chinese ; Patient Health Questionnaire-9 ; Glycemic control ; Somatization
• 刊名：Journal of Affective Disorders
• 出版年：2013
• 出版时间：November, 2013
• 年：2013
• 卷：151
• 期：2
• 页码：660-666
• 全文大小：388 K

文摘

Background

Depression is common in type 2 diabetes although the prevalence in Chinese patients remains unclear. We validated the Patient Health Questionnaire(PHQ-9), a popular depression screening tool, in Chinese with type 2 diabetes, and documented the prevalence, demographic,and clinical characteristics associated with depression.

Methods

A consecutive cohort of 586 Hong Kong Chinese outpatients completed the PHQ-9 during comprehensive diabetes complication assessment. Within 2-4 weeks, 40 patients were retested via telephone survey. Ninety-nine randomly selected patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview as a golden standard. Receiver operating characteristic curve was used to assess performance of the PHQ-9.

Results

The internal consistency of the PHQ-9 was 0.86 and test-retest reliability was 0.70. The 3 somatic items explained 53.6 % of the PHQ-9 score. The optimal cutoff value was 7 with 82.6 % sensitivity and 73.7 % specificity, giving a depression prevalence of 18.3 % (n=107). Of these, 18.7 % had been previously diagnosed with depression. Depression was more prevalent in women than men. After controlling for confounders, patients with depression had higher HbA1c (7.80¡À1.86 % versus 7.43¡À1.29 % , [61.7¡À20.4 versus 57.8¡À14.1 mmol/mol], P<0.05), reduced likelihood of achieving HbA1c target of <7.0 % (33.6 % versus 41.8 % , P<0.05), and were more likely to have self-reported hypoglycemia in the previous 3 months (18.7 % versus 6.7 % , P<0.01).

Limitation

A small sample was used in the criterion validation and the cross-sectional design precludes causal inference.

Conclusions

PHQ-9 is a validated tool for screening for depression, which is common and frequently undiagnosed in Chinese type 2 diabetic patients and is associated with suboptimal glycemic control, hypoglycemia, and somatization.