Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales Among Adults Living with HIV/AIDS in Western Kenya

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• 作者：Patrick O. Monahan PhD (1)
  Enbal Shacham PhD (2)
  Michael Reece PhD ; MPH (3)
  Kurt Kroenke MD (4)
  Willis Owino Ong’or MMEd ; MPH (6)
  Otieno Omollo MBChB ; MMed (6)
  Violet Naanyu Yebei MA (5) (6)
  Claris Ojwang (7)
  
• 关键词：HIV/AIDS ; Kenya ; Africa ; depression ; PHQ ; 9
• 刊名：Journal of General Internal Medicine
• 出版年：2009
• 出版时间：February 2009
• 年：2009
• 卷：24
• 期：2
• 页码：189-197
• 全文大小：240KB
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• 作者单位：Patrick O. Monahan PhD (1)
  Enbal Shacham PhD (2)
  Michael Reece PhD, MPH (3)
  Kurt Kroenke MD (4)
  Willis Owino Ong’or MMEd, MPH (6)
  Otieno Omollo MBChB, MMed (6)
  Violet Naanyu Yebei MA (5) (6)
  Claris Ojwang (7)
  
  1. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
  2. Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO, USA
  3. Department of Applied Health Science, Indiana University, Bloomington, IN, USA
  4. Regenstrief Institute for Health Care and Department of Medicine, Indiana University, Indianapolis, IN, USA
  6. School of Medicine, Moi University, Eldoret, Kenya
  5. Department of Sociology, Indiana University, Bloomington, IN, USA
  7. AMPATH Support Network, Moi University, Eldoret, Kenya
  

文摘

Background 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. Objective To assess the validity/reliability of PHQ-9 and PHQ-2. Design Observational, two occasions 7 days apart. Participants A total of 347 patients attending psychosocial support groups. Measurements Demographics, PHQ-9, PHQ-2, general health perception rating and CD4 count. Results 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 ? 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 (18-5, 36-1) subgroups. Conclusions 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.