Journal of General Internal Medicine

, Volume 23, Issue 12, pp 2014–2017

Optimizing Detection of Major Depression Among Patients with Coronary Artery Disease Using the Patient Health Questionnaire: Data from the Heart and Soul Study

  • Brett D. Thombs
  • Roy C. Ziegelstein
  • Mary A. Whooley
Brief Report

DOI: 10.1007/s11606-008-0802-y

Cite this article as:
Thombs, B.D., Ziegelstein, R.C. & Whooley, M.A. J GEN INTERN MED (2008) 23: 2014. doi:10.1007/s11606-008-0802-y



Clinical guidelines recommend depression screening in patients with coronary artery disease (CAD), but how to accomplish this is unclear.


We evaluated the test characteristics of the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), and a two-step screening approach (PHQ-2 then PHQ-9 if positive on PHQ-2), compared with the Computerized Diagnostic Interview Schedule (C-DIS) for major depression. We also evaluated a “PHQ diagnosis” of depression, requiring five of nine symptoms “more than half the days,” compared with the C-DIS.


Cross-sectional study of 1,024 outpatients with CAD.


Two hundred twenty-four patients (22%) had current major depression. Optimal cutpoints were ≥2 for the PHQ-2 (82% sensitive, 79% specific) and ≥6 for the PHQ-9 (83% sensitive, 76% specific). The two-step screening approach was less sensitive (75%), but more specific (84%), than the PHQ-2 or PHQ-9 alone. The “PHQ diagnosis” had low sensitivity (28%), but high specificity (96%).


Cutpoints of ≥2 on the PHQ-2 and ≥6 on the PHQ-9 had similar test characteristics. A two-step approach using the PHQ-2 followed by the PHQ-9 was no better than either instrument alone. A “PHQ diagnosis” of depression had high specificity, but poor sensitivity.


diagnostic accuracysensitivityspecificitycardiovascular diseasedepressionscreening

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Brett D. Thombs
    • 1
  • Roy C. Ziegelstein
    • 2
  • Mary A. Whooley
    • 3
    • 4
    • 5
  1. 1.Department of PsychiatryMcGill University and Sir Mortimer B. Davis-Jewish General HospitalMontrealCanada
  2. 2.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  4. 4.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  5. 5.Veterans Affairs Medical CenterSan FranciscoUSA