Jaivir S Rathore1, Lara E Jehi2, Youran Fan3, Sima I Patel4, Nancy Foldvary-Schaefer5, Maya J Ramirez6, Robyn M Busch7, Nancy A Obuchowski8, George E Tesar9. 1. Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Neurology and Rehabilitation, Neuropsychiatric Institute, University of Illinois Medical Center at Chicago (UIC), IL, USA. Electronic address: neurocare9@gmail.com. 2. Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: JEHIL@ccf.org. 3. Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: FanY2@ccf.org. 4. Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; MINCEP Epilepsy Care, University of Minnesota Medical Center, Minneapolis, MN, USA. Electronic address: sipatel12@gmail.com. 5. Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: foldvan@ccf.org. 6. Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Psychology Services, Tampa General Hospital, Tampa, FL, USA. Electronic address: maya.ramirez@gmail.com. 7. Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: buschr@ccf.org. 8. Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: obuchon@ccf.org. 9. Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: TESARG@ccf.org.
Abstract
OBJECTIVE: This study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. METHODS: Tertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a "gold standard" instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy. RESULTS: The calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but not different from the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864). SIGNIFICANCE: The PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.
OBJECTIVE: This study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. METHODS: Tertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a "gold standard" instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy. RESULTS: The calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but not different from the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864). SIGNIFICANCE: The PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.
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