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



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.


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


Observational, two occasions 7 days apart.


A total of 347 patients attending psychosocial support groups.


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


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.


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.


HIV/AIDS Kenya Africa depression PHQ-9 



This project was sponsored in part by funding provided by the Presidential Emergency Plan for AIDS Relief to the USAID-AMPATH® partnership. AMPATH is a registered trademark of the Trustees of Indiana University, Moi University and Moi Teaching and Referral Hospital. This project was also supported by funding from the School of Health, Physical Education, and Recreation and the Department of Applied Health Science at Indiana University-Bloomington.

Conflict of Interest

None disclosed.


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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

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