The Usefulness of the 9-item Patient Health Questionnaire (PHQ-9) to Screen Major Depression for Patients on a Palliative Care Unit: A Case That without No Regular Psychiatrist

Background: Mental assessment for patients in a palliative care unit with no regular psychiatrist tends to depend on subjective judgments by other health professionals. We introduced the 9-item Patient Health Questionnaire (PHQ-9) to screen major depression from patients in a palliative care unit and assessed the usefulness of the questionnaire. Methods: The subjects were all patients who were admitted to a palliative care unit. Each patient was asked to answer the PHQ-9 on admission and then was interviewed by a psychiatrist. When PHQ-9 score was of 10 points and above, the case was judged to be positive for depressive disorder. A psychiatrist diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). Results: A total of 83 patients were hospitalized between January 2016 and October 2016. 50 patients completed PHQ-9 and psychiatrist’s interview. Nine cases were positive by PHQ-9 and diagnosed as depressive disorder by a psychiatrist. Seven cases were positive by the PHQ-9 but not diagnosed as depressive disorder. Although 34 cases were judged to be negative by the PHQ-9, 2 cases of them were diagnosed as depressive disorder. The sensitivity and specificity of the PHQ-9 were 81.8% and 82.1% respectively. Conclusion: We found that the PHQ-9 was useful screening test for depression even in palliative care settings.

Diagnostic test of screening depressive disorders in general hospital with the Patient Health Questionnaire / 中国心理卫生杂志

Objective:Using a diagnostic test research,to explore the reliability and validity of the Patient Health Questionnaire (PHQ-9)on screening of depressive disorders in general hospital,and to determine the cut points for depressions with different severities.Methods:Three hundred and nineteen help-seekers (n =319)con-sulting the outpatient department of psychiatry in a general hospital were collected continuously.Among them,80 were people without any psychiatric diagnosis,239 were patients with mental disorders.All of subjects were asked to fulfill PHQ-9,and were assessed by psychiatrist with Mini-International Neuropsychiatric Interview (M.I.N.I.) and Hamilton rating scale for depression.M.I.N.I.was gold standard to diagnose depressive disorder,HRSD was used to assess the illness severity.Result:Factor analysis showed good structure validity of PHQ-9.46 patients were diagnosed depressive disorders.The area under the receiver operator characteristic analysis (ROC)of PHQ-9 was 0.94 (95%CI:0.91 -0.97)for depressive disorders.With 15 as the critical value for depression screening,the sen-sitivity was 0.83 and specificity was 0.90,respectively.By the result of HRSD as the standard to rank different lev-els of depression,the cut points of PHQ-9 for mild,moderate,and severe depression was 6,12,and 15.The consis-tency between results of PHQ-9 (with cut points of 6,12,15)and HRSD was moderate (with kappa =0.49).The kappa between results of PHQ-9 (with recommended cut points of 5,10,and 15)and HRSD was 0.46.Cronbach αcoefficient of PHQ-9 was 0.892.Conclusion:It suggests that PHQ-9 has satisfying reliability and validity,and is applicable for screening depression and assessment of its severity of outpatients in general hospital.The recommen-ded cut points of PHQ-9 are applicable to depressive outpatients in general hospital in China.