Background and Objectives Depression has been reported in up to 60% of patients with chronic hepatitis C (HCV). Various questionnaires have been used to screen for depression in this population. We examined the test characteristics of the PHQ-9, a new screening tool that has been validated in the general population but not among patients with HCV. With only nine items that parallel the DSM-IV criteria for major depressive disorder, the PHQ-9 is significantly shorter than most available questionnaires. It has also been validated for administration over the telephone.
Methods The Patient Health Questionnaire 9 (PHQ-9, 9 items), Center for Epidemiologic Studies Depression scale (CES-D, 20 items), and Beck Depression Inventory II (BDI-II, 21 items) were administered to 129 consecutive patients with chronic HCV attending a specialty clinic between August 2003 and April 2006. We used the BDI-II as the reference standard to calculate sensitivity and specificity.
Results Among the 129 patients screened, 82% were Caucasian, with 50.4% females, and their mean age was 47.4 ± 8.9 years (range 25-72). Fifty-two percent of participants (67/129) reported to their clinician symptoms suggesting underlying depression. The prevalence of depression was 63% using the BDI-II, 75% per the PHQ-9, and 71% per the CES-D. Patients on interferon had higher mean scores compared with patients not treated with interferon on all three questionnaires, with an absolute difference in mean scores of 3.2 on the BDI-II, 4.2 on the CES-D, and 2.4 on the PHQ-9; however, this was not statistically significant. We observed a strong correlation between the BDI-II and the CES-D (r = .85; p < .05) and the BDI-II and PHQ-9 (r = .84; p < .05). The sensitivity and specificity of the PHQ-9 were 92% (95% CI 88-96) and 61% (95% CI 48-70), respectively, whereas the CES-D had a sensitivity of 84% (95% CI 79.5-87) and a specificity of 87% (95% CI 75-94).
Conclusion Depression was highly prevalent among patients with chronic HCV attending a specialty clinic. Despite its lower specificity, the PHQ-9 is a very sensitive screening tool for depression in this patient population. The PHQ-9 offers advantages, including brevity and ease of administration.
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