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Objectives: To provide practical norms for measuring depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9) in Brazil through a state-of-the-art psychometrics analysis. Methods: We used a large representative dataset from the 2019 Brazilian National Health Survey (Pesquisa Nacional de Saúde - 2019), which included 90,846 Brazilian citizens. To assess scale structure, we assessed a unidimensional model using confirmatory factor analysis. Item response theory was used to characterize the distribution of depressive symptoms. Summed- and mean-based PHQ-9 scores were then linked using item response theory-based scores in generalized additive models. Finally, percentiles, T scores, and a newly developed score, called the decimal score (D score), were generated to describe PHQ-9 norms for the Brazilian population. Results: Confirmatory factor analysis revealed a good fit to the unidimensional model, being invariant to age and sex. Item response theory captured item-level information about the latent trait (reliable from 1 to 3 SDs above the mean). Brazilian norms were presented using summed scores, T scores, and D scores. Conclusion: This is the first study to determine Brazilian norms for the PHQ-9 among a large representative sample using robust psychometric tools. More precise PHQ-9 scores are now available and may be widely used in primary and specialized clinical care settings.
RESUMO
Objective To study the metabolic changes of cerebellum in patients with post-stroke depression (PSD) by proton magnetic resonance spectroscopy (1H-MRS) and discuss the relationships between the cerebellar changes and depression severity. Methods Stroke patients were selected as the subjects in present study. Data of demographic characteristics, individual history and life style of all subjects were collected. Forty patients with stroke and 20 healthy volunteers as control (NORM group) were enrolled. Hamilton Depression Scale (HAMD) and Self-rating Depression Scale (SDS) were used to test the subjects. According to the scores of depression severity, the stroke group was further divided into a group with post-stroke depression (PSD group) and a group without post-stroke depression (CONT group). All the patients of 2 groups received T1WI, T2WI, DWI and 1H-MRS examination. The cerebral infarction volume and the distribution and severity of leukoaraiosis were evaluated. The ratios of NAA/Cr, Cho/Cr and Cho/NAA in the cerebellum were calculated. Moreover, the relationships between the ratios and the scores of HAMD were analyzed in all post-stroke patients. Results There was no significant difference in the ratios of NAA/Cr, Cho/Cr and Cho/NAA in bilateral cerebellum between CONT group and normal control (NORM) group (P>0.05). The Cho/Cr and Cho/NAA ratios in the cerebellum contralateral to the stroke region were higher in PSD group than in NORM and CONT groups (P0.05). However, there was no significant difference in the NAA/Cr ratios in bilateral cerebellum among three groups (P>0.05). The family APGAR questionnaire survey scores, age-related white matter changes (ARWMC) scale total scores, 14-day National Institutes of Health Stroke Scale (NIHSS) scores, and the Cho/Cr and Cho/NAA ratios in the contralateral cerebellum were associated with post-stroke depression. Multiple linear regression analysis showed the Cho/Cr and Cho/NAA ratios were related to the HAMD scales (P<0.05). Conclusion The results preliminarily reveal that the cerebellum involves in the development of post-stroke depression.