PHQ-9 and PHQ-2 in Western Kenya
To the Editors:—Recently, Monahan et al. concluded that the PHQ-2 and PHQ-9 were “valid/reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in Western Kenya”1. However, they did not actually use any accepted assessment tool to diagnose DSM-IV depressive disorders. Instead, they used a “diagnosis” of depression based on the self-report PHQ-9 as their criterion standard. A recent meta-analysis2 found that the PHQ-9 was acceptable for depression screening, but it was not superior to results from other depression screening tools in identifying cases of depression,3 and it was poorly sensitive in some patient groups2. Based on the authors use of the PHQ-9 as a diagnostic criterion, one might conclude that any depression questionnaire could appropriately be substituted for a gold standard structured interview. This is clearly not the case, and the PHQ-9 is not appropriate for that purpose either.
Monahan et al. arrived at an inflated es ...
- Monahan PO, Enbal Shacham E, Reece M, et al. Validity/reliability of PHQ-9 and PHQ-2 Depression Scales among adults living with HIV/AIDS in Western Kenya. JGIM. 2009;24:189–97. CrossRef
- Gilbody S, Richards D, Brealey S, et al. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): A diagnostic meta-analysis. JGIM. 2007;22:1596–602. CrossRef
- Williams JW Jr., Pignone M, Ramirez G, et al. Identifying depression in primary care: A literature synthesis of case-finding instruments. Gen Hosp Psychiatry. 2002;24:225–37. CrossRef
- Whiting, P, Rutjes AWS, Reitsma, JB, Bossuyt, PMM, Kleijnen1, J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Research Methodology. 3:25
- Mitchell AJ, Coyne JC. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. BJGP. 2007;57:144–51.
- Gilbody S, Sheldon T, House A. Screening and case-finding instruments for depression: a meta-analysis. CMAJ. 2008;178:997–1003.
- PHQ-9 and PHQ-2 in Western Kenya
Journal of General Internal Medicine
Volume 24, Issue 7 , p 890
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- 1. Department of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market St. Rm 676, Philadelphia, PA, 19106, USA
- 2. McGill University and Jewish General Hospital, Montreal, Quebec, Canada
- 3. Department of Cancer & Molecular Medicine, Leicester Royal Infirmary, Leicester, UK