Mary C Smith Fawzi1, Fileuka Ngakongwa2, Yuanyuan Liu1, Theonest Rutayuga2, Hellen Siril3, Magreat Somba4, Sylvia F Kaaya2. 1. Harvard Medical School, Department of Global Health and Social Medicine, Boston MA, USA. 2. Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, Dar es Salaam, Tanzania. 3. Management and Development for Health, Dar es Salaam, Tanzania. 4. Africa Academy for Public Health, Dar es Salaam, Tanzania.
Abstract
BACKGROUND: Major depression has a significant impact on years lived with disability (YLD) globally. In resource-limited countries, depression may accompany daily challenges of economic security that people face, hence there is a critical need to develop depression screening tools at primary levels of health care. The overall goal of the study is to validate the PHQ-9 in Tanzania. METHODS: A validation study was conducted from August to October 2014 among adults accessing primary health care at public clinics in Dar es Salaam. The Mini-International Neuropsychiatric Interview (MINI) was used as the gold standard for current major depressive episode. RESULTS: Among 180 patients recruited, six were not included in the analysis since the PHQ-9 and MINI assessments were conducted more than two weeks apart (n=174). The PHQ-9 demonstrated reasonable reliability in this setting (α=0.83). Evidence for construct validity was observed through expected associations with female gender (r=0.16, p=0.04) and food insecurity (r=0.30, p<0.0001). Receiver Operating Characteristic analysis demonstrated good overall accuracy of the PHQ-9 (AOC=0.87, 95%CI: 0.77, 0.96). The optimal cut-off score in this population was 9, with a sensitivity of 78% and specificity of 87%. LIMITATIONS: The study sample is from a primary health care setting, hence the findings may have some limited generalizability at the community level. CONCLUSIONS: The PHQ-9 demonstrated reliability and validity among adults accessing primary health care in Dar es Salaam, indicating that it can serve as a useful tool in identifying patients with depression in primary care clinics in Tanzania and similar settings.
BACKGROUND: Major depression has a significant impact on years lived with disability (YLD) globally. In resource-limited countries, depression may accompany daily challenges of economic security that people face, hence there is a critical need to develop depression screening tools at primary levels of health care. The overall goal of the study is to validate the PHQ-9 in Tanzania. METHODS: A validation study was conducted from August to October 2014 among adults accessing primary health care at public clinics in Dar es Salaam. The Mini-International Neuropsychiatric Interview (MINI) was used as the gold standard for current major depressive episode. RESULTS: Among 180 patients recruited, six were not included in the analysis since the PHQ-9 and MINI assessments were conducted more than two weeks apart (n=174). The PHQ-9 demonstrated reasonable reliability in this setting (α=0.83). Evidence for construct validity was observed through expected associations with female gender (r=0.16, p=0.04) and food insecurity (r=0.30, p<0.0001). Receiver Operating Characteristic analysis demonstrated good overall accuracy of the PHQ-9 (AOC=0.87, 95%CI: 0.77, 0.96). The optimal cut-off score in this population was 9, with a sensitivity of 78% and specificity of 87%. LIMITATIONS: The study sample is from a primary health care setting, hence the findings may have some limited generalizability at the community level. CONCLUSIONS: The PHQ-9 demonstrated reliability and validity among adults accessing primary health care in Dar es Salaam, indicating that it can serve as a useful tool in identifying patients with depression in primary care clinics in Tanzania and similar settings.
Entities:
Keywords:
Depression; PHQ-9; Tanzania; primary health care; screening; validity
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