Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care: Journal of Affective Disorders

G. L. van der Zwaan, S. E. M. van Dijk, M. C. Adriaanse, H. W. J. van Marwijk, M. W. van Tulder, A. D. Pols, Judith E. Bosmans

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. Methods: In this cross-sectional study, 586 consecutive DM2/CHD patients aged > 18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. Results: For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. Limitations: Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. Conclusions: The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression. (C) 2015 Elsevier B.V. All rights reserved.
Original languageEnglish
Pages (from-to)68-74
Number of pages7
JournalJournal of Affective Disorders
Volume190
DOIs
Publication statusPublished - 2016

Cite this

van der Zwaan, G. L. ; van Dijk, S. E. M. ; Adriaanse, M. C. ; van Marwijk, H. W. J. ; van Tulder, M. W. ; Pols, A. D. ; Bosmans, Judith E. / Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care : Journal of Affective Disorders. In: Journal of Affective Disorders. 2016 ; Vol. 190. pp. 68-74.
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title = "Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care: Journal of Affective Disorders",
abstract = "Background: Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. Methods: In this cross-sectional study, 586 consecutive DM2/CHD patients aged > 18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. Results: For minor depression, the optimal cut-off score was 8 (sensitivity 71{\%}, specificity 71{\%} and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84{\%}, a specificity of 82{\%}, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25{\%} and 33{\%}, respectively. Limitations: Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10{\%} of all invited patients could be included in the analyses. This could have resulted in biased outcomes. Conclusions: The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression. (C) 2015 Elsevier B.V. All rights reserved.",
author = "{van der Zwaan}, {G. L.} and {van Dijk}, {S. E. M.} and Adriaanse, {M. C.} and {van Marwijk}, {H. W. J.} and {van Tulder}, {M. W.} and Pols, {A. D.} and Bosmans, {Judith E.}",
note = "ISI Document Delivery No.: CY5QT Times Cited: 4 Cited Reference Count: 38 van der Zwaan, G. Lennart van Dijk, Susan E. M. Adriaanse, Marcel C. van Marwijk, Harm W. J. van Tulder, Maurits W. Pols, Alide D. Bosmans, Judith E. van Tulder, Maurits/0000-0002-7589-8471 ZonMw, the Netherlands Organisation for Health Research and Development [80-82310-97-12110] Funding by ZonMw, the Netherlands Organisation for Health Research and Development (project number 80-82310-97-12110) was obtained. ZonMw did not have any role in the study design, the collection-, analyses- and interpretation of the data, writing of the report or the decision to submit this report for publication. 4 3 7 ELSEVIER SCIENCE BV AMSTERDAM J AFFECT DISORDERS",
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Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care : Journal of Affective Disorders. / van der Zwaan, G. L.; van Dijk, S. E. M.; Adriaanse, M. C.; van Marwijk, H. W. J.; van Tulder, M. W.; Pols, A. D.; Bosmans, Judith E.

In: Journal of Affective Disorders, Vol. 190, 2016, p. 68-74.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Diagnostic accuracy of the Patient Health Questionnaire-9 for assessment of depression in type II diabetes mellitus and/or coronary heart disease in primary care

T2 - Journal of Affective Disorders

AU - van der Zwaan, G. L.

AU - van Dijk, S. E. M.

AU - Adriaanse, M. C.

AU - van Marwijk, H. W. J.

AU - van Tulder, M. W.

AU - Pols, A. D.

AU - Bosmans, Judith E.

N1 - ISI Document Delivery No.: CY5QT Times Cited: 4 Cited Reference Count: 38 van der Zwaan, G. Lennart van Dijk, Susan E. M. Adriaanse, Marcel C. van Marwijk, Harm W. J. van Tulder, Maurits W. Pols, Alide D. Bosmans, Judith E. van Tulder, Maurits/0000-0002-7589-8471 ZonMw, the Netherlands Organisation for Health Research and Development [80-82310-97-12110] Funding by ZonMw, the Netherlands Organisation for Health Research and Development (project number 80-82310-97-12110) was obtained. ZonMw did not have any role in the study design, the collection-, analyses- and interpretation of the data, writing of the report or the decision to submit this report for publication. 4 3 7 ELSEVIER SCIENCE BV AMSTERDAM J AFFECT DISORDERS

PY - 2016

Y1 - 2016

N2 - Background: Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. Methods: In this cross-sectional study, 586 consecutive DM2/CHD patients aged > 18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. Results: For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. Limitations: Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. Conclusions: The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression. (C) 2015 Elsevier B.V. All rights reserved.

AB - Background: Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. Methods: In this cross-sectional study, 586 consecutive DM2/CHD patients aged > 18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. Results: For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. Limitations: Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. Conclusions: The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression. (C) 2015 Elsevier B.V. All rights reserved.

U2 - 10.1016/j.jad.2015.09.045

DO - 10.1016/j.jad.2015.09.045

M3 - Article

VL - 190

SP - 68

EP - 74

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -