VALIDITY OF THE CHINESE LANGUAGE VERSION OF THE PATIENT HEALTH QUESTIONNAIRE-9 (PHQ-9) FOR DEPRESSION SCREENING: A SYSTEMATIC REVIEW

ABSTRACT

BACKGROUND: Depression is a major public health issue, yet Chinese Americans are less likely to be diagnosed and have their symptoms treated. Chinese Americans with Limited English Proficiency (LEP) have higher mental health needs than their English-proficient counterparts but have significantly lower rates of mental health service utilization. Furthermore, the increase in anti-Asian hate crimes during the COVID-19 pandemic has increased the urgency to accurately detect depression in this community. This systematic review examines the validity of the PHQ-9 for depression screening in Chinese-speaking populations. METHODS: We conducted a systematic review of English and Chinese articles in PubMed, Web of Science, Embase, and the PsycINFO databases examining studies through September 2021. Studies were included if they evaluated the Chinese language PHQ-9, conducted a clinical interview (gold standard) to diagnose depression and depressive symptoms, and included measures of validity and efficacy of the PHQ-9. We included studies conducted in the US and abroad, regardless of the Chinese language spoken, as most relied on the same written Chinese PHQ-9. Three investigators independently reviewed titles and s for all citations to identify studies that met inclusion criteria, which advanced to full-text review. Using a standardized data extraction form, we ed country and setting, participant characteristics, sample size, study design, years of study, gold standard utilized, and outcome measures. Two investigators independently assessed the study quality using the QUADAS-2 (which is specific for assessing potential for bias in studies of diagnostic accuracy). RESULTS: Our search identified 424 articles;44 articles received a full text review. Of those, 14 articles (N= 10,813 participants), conducted in Mainland China (N=12), Hong Kong (N=1), and the United States (N=1), met inclusion criteria and were included in the review. Studies were diverse in terms of participant age, comorbidities, and setting. Gold standards used included MINI (N=7), SCID (N=6), and DSM-V (N=1). Overall, Cronbach's alpha ranged from 0.80-0.94 for included studies and optimal cutoff scores ranged from 6-15. Studies had an overall low risk for bias. CONCLUSIONS: While there were limited studies and variable reference standards used, the Chinese language version of the PHQ-9 appears to be a valid depression screening tool among Chinese-speaking populations in multiple countries and various clinical settings. Further research should explore the optimal cut-off score for this population.