Journal of General Internal Medicine

, 24:189

Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales Among Adults Living with HIV/AIDS in Western Kenya

  • Patrick O. Monahan
  • Enbal Shacham
  • Michael Reece
  • Kurt Kroenke
  • Willis Owino Ong’or
  • Otieno Omollo
  • Violet Naanyu Yebei
  • Claris Ojwang
Original Article

DOI: 10.1007/s11606-008-0846-z

Cite this article as:
Monahan, P.O., Shacham, E., Reece, M. et al. J GEN INTERN MED (2009) 24: 189. doi:10.1007/s11606-008-0846-z

Abstract

Background

Depression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings.

Objective

To assess the validity/reliability of PHQ-9 and PHQ-2.

Design

Observational, two occasions 7 days apart.

Participants

A total of 347 patients attending psychosocial support groups.

Measurements

Demographics, PHQ-9, PHQ-2, general health perception rating and CD4 count.

Results

Rates for PHQ-9 DSM-IV major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder were 13%, 21% and 34%. Depression was associated with female gender, but not CD4. Construct validity was supported by: (1) a strong association between PHQ-9 and general health rating, (2) a single major factor with loadings exceeding 0.50, (3) item-total correlations exceeding 0.37 and (4) a pattern of item means similar to US validation studies. Four focus groups indicated culturally relevant content validity and minor modifications to the PHQ-9 instructions. Coefficient alpha was 0.78. Test-retest reliability was acceptable: (1) intraclass correlation 0.59 for PHQ-9 total score, (2) kappas 0.24, 0.25 and 0.38 for PHQ-9 MDD, ODD and any depressive disorder and (3) weighted kappa 0.53 for PHQ-9 depression severity categories. PHQ-2 ≥3 demonstrated high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively, for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18–35, 36–61) subgroups.

Conclusions

PHQ-9 and PHQ-2 appear valid/reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in western Kenya.

KEY WORDS

HIV/AIDSKenyaAfricadepressionPHQ-9

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Patrick O. Monahan
    • 1
  • Enbal Shacham
    • 2
  • Michael Reece
    • 3
  • Kurt Kroenke
    • 4
  • Willis Owino Ong’or
    • 6
  • Otieno Omollo
    • 6
  • Violet Naanyu Yebei
    • 5
    • 6
  • Claris Ojwang
    • 7
  1. 1.Department of MedicineIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of Psychiatry, School of MedicineWashington UniversitySt. LouisUSA
  3. 3.Department of Applied Health ScienceIndiana UniversityBloomingtonUSA
  4. 4.Regenstrief Institute for Health Care and Department of MedicineIndiana UniversityIndianapolisUSA
  5. 5.Department of SociologyIndiana UniversityBloomingtonUSA
  6. 6.School of MedicineMoi UniversityEldoretKenya
  7. 7.AMPATH Support NetworkMoi UniversityEldoretKenya