Pillaveetil Sathyadas Indu1, Thekkethayyil Viswanathan Anilkumar2, Krishnapillai Vijayakumar3, K A Kumar4, P Sankara Sarma5, Saradamma Remadevi6, Chittaranjan Andrade7. 1. Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India. Electronic address: indups@tmc.kerala.gov.in. 2. Department of Psychiatry, Government Medical College, Trivandrum, Kerala, India. 3. Department of Community Medicine, Government Medical College, Trivandrum, Kerala, India. 4. Former Director of Medical Education, Kerala, India. 5. Department of Biostatistics, Achutha Menon Centre for Health Science Studies, Sree Chithira Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. 6. School of Health Policy and Planning, Kerala University of Health Sciences, Kerala, India. 7. Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India.
Abstract
BACKGROUND: Depression is twice more prevalent among women but remains unidentified in primary care. OBJECTIVE: We aimed to estimate the reliability and validity of PHQ-9, when administered by health workers, a cadre of public health staff, posted in primary health centres. We translated PHQ-9 to Malayalam, a language spoken by 30 million people in Kerala, India. Health workers administered PHQ-9 to women (n = 238) aged 18-60 years in a high prevalent primary care setting. Mini International Neuropsychiatric Interview (MINI) was administered by the psychiatrist on the same day to diagnose depressive disorder. Two health workers administered PHQ-9, independently, in a subset of 21 women. RESULTS: The internal consistency reliability (Cronbach's alpha 0.89) and inter-rater reliability (intra class correlation coefficient, 0.94; 95% CI, 0.86-0.95) were high. On ROC analysis, area under curve was 0.92 (95% CI 0.88-0.96). For a cut-off score of ≥9, PHQ-9 had a sensitivity of 82.5%, (95% CI, 72.4-92.6), specificity of 90.1% (95% CI, 84.5-95.6%), positive predictive value of 73.4% (95% CI, 62.4-84.4%) and negative predictive value of 93.9% (95% CI, 90.2-97.6%). The accuracy was 88.2% (84.0-92.4%) and positive likelihood ratio was 8.3. Factor analysis supported a single factor, with eigen value above 1, with high loading for all items (0.73-0.79), except item related to appetite (0.58). This explained 62% of variance in the data. Prevalence of MINI diagnosed depressive disorders was 25%. CONCLUSION: When administered by health workers, PHQ-9 has good reliability and at cut off score ≥9, it has good validity to identify depression in primary care.
BACKGROUND:Depression is twice more prevalent among women but remains unidentified in primary care. OBJECTIVE: We aimed to estimate the reliability and validity of PHQ-9, when administered by health workers, a cadre of public health staff, posted in primary health centres. We translated PHQ-9 to Malayalam, a language spoken by 30 million people in Kerala, India. Health workers administered PHQ-9 to women (n = 238) aged 18-60 years in a high prevalent primary care setting. Mini International Neuropsychiatric Interview (MINI) was administered by the psychiatrist on the same day to diagnose depressive disorder. Two health workers administered PHQ-9, independently, in a subset of 21 women. RESULTS: The internal consistency reliability (Cronbach's alpha 0.89) and inter-rater reliability (intra class correlation coefficient, 0.94; 95% CI, 0.86-0.95) were high. On ROC analysis, area under curve was 0.92 (95% CI 0.88-0.96). For a cut-off score of ≥9, PHQ-9 had a sensitivity of 82.5%, (95% CI, 72.4-92.6), specificity of 90.1% (95% CI, 84.5-95.6%), positive predictive value of 73.4% (95% CI, 62.4-84.4%) and negative predictive value of 93.9% (95% CI, 90.2-97.6%). The accuracy was 88.2% (84.0-92.4%) and positive likelihood ratio was 8.3. Factor analysis supported a single factor, with eigen value above 1, with high loading for all items (0.73-0.79), except item related to appetite (0.58). This explained 62% of variance in the data. Prevalence of MINI diagnosed depressive disorders was 25%. CONCLUSION: When administered by health workers, PHQ-9 has good reliability and at cut off score ≥9, it has good validity to identify depression in primary care.
Authors: Noelle E Carlozzi; Siera Goodnight; Anna L Kratz; Julie C Stout; Michael K McCormack; Jane S Paulsen; Nicholas R Boileau; David Cella; Rebecca E Ready Journal: J Huntingtons Dis Date: 2019
Authors: Ashley Moore; Joris Adriaan Frank van Loenhout; Maria Moitinho de Almeida; Pierre Smith; Debarati Guha-Sapir Journal: Glob Health Action Date: 2020-12-31 Impact factor: 2.640