Abstract
Background and Objectives We examined the test characteristics of the PHQ-9, a new screening tool that has been validated in the general population but not amongst patients with hepatitis C virus (HCV). Methods The PHQ-9, CES-D and BDI-II questionnaires were administered to 129 consecutive patients with chronic HCV attending a specialty clinic between August 2005 and April 2006. Results Approximately 52% of participants reported symptoms suggesting depression. Prevalence of depression was 62% using the BDI-II, 75% per the PHQ-9 and 72% per the CES-D. We observed a strong correlation between the BDI-II, CES-D and PHQ-9 in patients on and off interferon. Scores on the three questionnaires were only moderately associated with symptoms reported by the patients. There was moderate agreement between the CES-D and BDI-II and slight agreement between both these questionnaires and the PHQ-9. Scores on the PHQ-9 correlated strongly with scores on the CES-D and BDI-II and moderately with patients’ symptoms.
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Alter MJ, Kruszon-Moran D, Nainan OV, McQuillan GM, Gao F, Moyer LA, Kaslow RA, Margolis HS (1999) The prevalence of Hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 341:556–562
Gallegos-Orozco JF, Fuentes AP, Argueta JG, Perez-Pruna C, Hinojosa- Becerril C, Sixtos- Alonso MS, Cruz-Castellanos S, Gutierrez-Reyes G, Olivera- Martinez MA, Gutierrez- Ruiz MC, Kershenobich D (2003) Health-related quality of life and depression in patients with chronic Hepatitis C. Arch Med Res 34:124–129
Bonkovsky HL, Woolley JM (1999) Reduction of health-related quality of life in chronic Hepatitis C and improvement with interferon therapy. Hepatology 29:264–270
Foster GR, Goldin RD, Thomas HC (1998) Chronic Hepatitis C virus infection causes a significant-reduction in quality of life in the absence of cirrhosis. Hepatology 27:209–212
Dieperink E, Willenbring M, Ho SB (2000) Neuropsychiatric symptoms associated with Hepatitis C and interferon alpha: a review. Am J Psychiatry 157:867–876
Johnson ME, Fisher DG, Fenaughty A, Theno SA (1998) Hepatitis C and depression in drug users. Am J Gastroenterol 93:785–789
Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Goncales FL, Haussinger D, Diago M, Carosi G, Dhumeaux D, Craxi A, Lin A, Hoffman J, Yu J (2002) Peginterferon Alfa-2a plus ribavirin for chronic Hepatitis C virus infection. N Engl J Med 347:975–982
McHutchison JG, Ware Jr JE, Bayliss MS, Pianko S, Albrecht JK, Cort S, Yang I, Neary MP (2001) The effects of interferon alpha-2b in combination with ribavirin on health related quality of life and work productivity. J Hepatol 34:140–147
Spiegel BMR, Younossi ZM, Hays RD, Revicki D, Robbins S, Kanwal F (2005) Impact of Hepatitis C on health related quality of life: a systematic review and quantitative assessment. Hepatology 41:790–800
Reichenberg A, Gorman JM, Dieterich DT (2005) Interferon-induced depression and cognitive impairment in Hepatitis C virus patients: a 72 week prospective study. AIDS 19(suppl 3):S174–S178
Crone CC, Gabriel GM, Wise TN (2004) Managing the neuropsychiatric side effects of interferon based therapy for hepatitis C. Cleve Clin J Med 71(suppl.3):S27–S32
Bernstein D, Kleinman L, Barker CM, Revicki DA, Green J (2002) Relationship of health-related quality of life to treatment adherence and sustained response in chronic hepatitis C patients. Hepatology 35:704–708
Janssen HL, Brouwer JT, van der Mast RC, Schalm SW (1994) Suicide associated with alfa-interferon therapy for chronic viral hepatitis. J Hepatol 21:241–243
Capuron L, Ravaud A (1999) Prediction of the depressive effects of interferon alfa therapy by the patient’s initial affective state. N Engl J Med 340:1370
Cotler SJ, Wartelle CF, Larson AM, Gretch DR, Jensen DM, Carithers Jr RL (2000) Pretreatment symptoms and dosing regimen predict side-effects of interferon therapy for Hepatitis C. J Viral Hepat 7:211–217
National Institutes of Health consensus Development Conference Statement: Management of hepatitis C:2002 June 10–12, 2002. Hepatology 2002;36(5 suppl 1):S3–S20
Musselman DL, Lawson DH, Gumnick JF, Manatunga AK, Penna S, Goodkin RS, Greiner K, Nemeroff CB, Miller AH (2001) Paroxetine for the prevention of depression induced by high dose interferon alfa. N Engl J Med 344:961–966
Hauser P, Khosla J, Aurora H, Laurin J, Kling MA, Hill J, Thornton AJ, Schultz RL, Valentine AD, Meyers CA , Howell CD (2002) A prospective study of the incidence and open-label treatment of interferon-induced major depressive disorder in patients with Hepatitis C. Mol Psychiatry 7:942–947
Kraus MR, Schafer A, Faller H, Csef H, Scheurlen M (2002) Paroxetine for the treatment of interferon-alpha-induced depression in chronic Hepatitis C. Aliment Pharmacol Ther 16:1091–1099
Golub ET, Latka M, Hagan H, Havens JR, Hudson SM, Kapadia F, Campbell JV, Garfein RS, Thomas DL, Strathdee SA (2004) Screening for depressive symptoms among HCV-infected injection drug users: examination of utility of the CES-D and the beck depression inventory. J Urban Health 81:278–290
Lowe B, Kroenke K, Herzog W, Grafe K (2004) Measuring depression outcome with a brief self report instrument: sensitivity to change of the Patient health Questionnaire(PHQ-9). J Affect Disord 81:61–66
Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, Blanco E, Haro JM (2005) Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone? J Gen Intern Med 20:738–742
Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9, validity of a brief depression severity measure. J Gen Intern Med 16:606–613
Martin A, Rief W, Klaiberg A, Braehler E (2006) Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hosp Psychiatry 28:71–77
Williams LS, Brizendine EJ, Plue L, Bakas T, Tu W, Hendrie H, Kroenke K (2005) Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke 36:635–638
Fann JR, Bombardier CH, Dikmen S, Esselman P, Warms CA, Pelzer E, Rau H, Temi N (2005) Validity of the patient health questionnaire-9 in assessing depression following brain injury. J Head Trauma Rehabil 20:501–511
Hann D, Winter K, Jacobsen P (1999) Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). J Psychosom Res 46:437–443
Clark CH, Mahoney JS, Clark DJ, Eriksen LR (2002) Screening for depression in a Hepatitis C population: the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D). J Adv Nurs 40:361–369
McDowell I, Newell C (1996) Measuring health a guide to rating scales and questionnaires, 2nd edn. Oxford University Press
Koskinas J, Merkouraki P, Manesis E, Hadziyannis S (2002) Assessment of depression in patients with chronic viral Hepatitis: effect of interferon treatment. Dig Dis 20:284–288
Shaefer M, Schwaiger M, Garkisch AS, Pich M, Hinzpeter A, Uebelhack R, Heinz A, van Boemmel F, Berg T (2005) Prevention of interferon-alpha associated depression in psychiatric risk patients with chronic Hepatitis C. J Hepatol 42:793–798
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Dbouk, N., Arguedas, M.R. & Sheikh, A. Assessment of the PHQ-9 as a Screening Tool for Depression in Patients with Chronic Hepatitis C. Dig Dis Sci 53, 1100–1106 (2008). https://doi.org/10.1007/s10620-007-9985-z
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DOI: https://doi.org/10.1007/s10620-007-9985-z