Advertisement

Academic Psychiatry

, Volume 38, Issue 6, pp 661–667 | Cite as

Usefulness of the Patient Health Questionnaire-9 for Korean Medical Students

  • Seoyoung Yoon
  • Yunhwan Lee
  • Changsu Han
  • Chi-Un Pae
  • Ho-Kyoung Yoon
  • Ashwin A. Patkar
  • David C. Steffens
  • Yong-Ku Kim
Empirical Report

Abstract

Objective

Depression may be highly prevalent among medical students, lowering their functioning and quality of life. Using appropriate extant depression scales to screen for depression and determining factors associated with depression can be helpful in managing it. This study examines the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) for medical students and the relationship between their scores and sociodemographic variables.

Methods

This study surveyed 174 medical students using demographic questionnaires, the PHQ-9, the Beck Depression Inventory (BDI), the Patient Heath Questionnaire-15 (PHQ-15), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). It calculated the Cronbach’s α for internal consistency and Pearson’s correlation coefficients for test-retest reliability and convergent validity of the PHQ-9. In order to examine the relationship between depression and demographic variables, this study performed independent t tests, one-way analysis of variance, chi-square, and binary logistic regressions.

Results

The PHQ-9 was reliable (Cronbach’s α = 0.837, test-retest reliability, r = 0.650) and valid (r = 0.509–0.807) when employed with medical students. Total scores on the PHQ-9 were significantly higher among low-perceived academic achievers than among high-perceived academic achievers (p < 0.01). Depression was more prevalent in poor-perceived academic achievers than in high-perceived academic achievers. Similarly, poor-perceived academic achievers were at greater risk of depression than were high-perceived academic achievers (odds ratio [95 % confidence interval] 3.686 [1.092–12.439], p < 0.05).

Conclusions

The PHQ-9 has satisfactory reliability and validity in medical students in South Korea. Depression is related to poor-perceived academic achievement when measured with the PHQ-9. Early screening for depression with the PHQ-9 in medical students and providing prompt management to high scorers may not only be beneficial to students’ mental health but also improve their academic performance.

Keywords

Medical students Emotional problems Psychological tests 

Notes

Acknowledgments

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI12C0003).

Disclosure

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Cho MJ. Abstract. In: The 2011 epidemiological survey of mental disorders among Korean adults. Seoul National University College of Medicine.2011. http://download.mw.go.kr/front_new/modules/download.jsp?BOARD_ID=1003&CONT_SEQ=274852&FILE_SEQ=113724. Accessed 10 Nov 2013
  2. 2.
    World Health Organization. Part 4: burden of disease: DALYs. In: The global burden of disease: 2004 update. World Health Organization.2008. http://www.who.int/entity/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Accessed 10 Nov 2013
  3. 3.
    Rost K, Nutting P, Smith J, Werner J, Duan N. Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality enhancement by strategic teaming. J Gen Intern Med. 2001;16(3):143–9.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    The U.S. Preventive Services Task Force. Screening for depression: recommendations and rationale. Ann Intern Med. 2002;136(10):760–4.CrossRefGoogle Scholar
  5. 5.
    Trivedi MH. Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission. J Clin Psychiatry. 2009;70 Suppl 6:26–31.PubMedCrossRefGoogle Scholar
  6. 6.
    Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Yusoff MS. Associations of pass-fail outcomes with psychological health of first-year medical students in a Malaysian medical school. Sultan Qaboos Univ Med J. 2013;13(1):107–14.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Han SS, Lee SY, Choi WS, Kim SJ, Park SB, Lee SY. Depression and its influencing factors among Korean medical and engineering students in urban areas using Zung Self-Rating depression scale. Korean J Fam Med. 2009;30:539–48.CrossRefGoogle Scholar
  9. 9.
    MacLeod RD, Parkin C, Pullon S, Robertson G. Early clinical exposure to people who are dying: learning to care at the end of life. Med Educ. 2003;37(1):51–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Yusoff MS, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. Prevalence and associated factors of stress, anxiety and depression among prospective medical students. Asian J Psychiatr. 2013;6(2):128–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Hojat M, Robeson M, Damjanov I, Veloski JJ, Glaser K, Gonnella JS. Students’ psychosocial characteristics as predictors of academic performance in medical school. Acad Med. 1993;68(8):635–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Cheng DR, Poon F, Nguyen TT, Woodman RJ, Parker JD. Stigma and perception of psychological distress and depression in Australian-trained medical students: results from an inter-state medical school survey. Psychiatry Res. 2013;209(3):684–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Furukawa TA. Assessment of mood: guides for clinicians. J Psychosom Res. 2010;68(6):581–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–602.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Han C, Jo SA, Kwak JH, Pae CU, Steffens D, Jo I, et al. Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study. Compr Psychiatry. 2008;49(2):218–23.PubMedCrossRefGoogle Scholar
  17. 17.
    Wulsin L, Somoza E, Heck J. The feasibility of using the Spanish PHQ-9 to screen for depression in primary care in Honduras. Prim Care Companion J Clin Psychiatr. 2002;4(5):191–5.CrossRefGoogle Scholar
  18. 18.
    Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006;28(1):71–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21(6):547–52.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Adewuya AO, Ola BA, Afolabi OO. Validity of the Patient Health Questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. J Affect Disord. 2006;96(1–2):89–93.PubMedCrossRefGoogle Scholar
  21. 21.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.PubMedCrossRefGoogle Scholar
  22. 22.
    Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D Scales. J Korean Psychol Assoc. 1991;10(1):98–113.Google Scholar
  23. 23.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Kwon SM. Differential roles of dysfunctional attitudes and automatic thoughts in depression: an integrated cognitive model of depression [doctoral thesis]. The University of Queensland; 1992Google Scholar
  25. 25.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66.PubMedCrossRefGoogle Scholar
  26. 26.
    Han C, Pae CU, Patkar AA, Masand PS, Kim KW, Joe SH, et al. Psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) for measuring the somatic symptoms of psychiatric outpatients. Psychosomatics. 2009;50(6):580–5.PubMedGoogle Scholar
  27. 27.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.PubMedCrossRefGoogle Scholar
  28. 28.
    Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapam S, Oskamp S, editors. The social psychology of health: Claremont Symposium on applied social psychology. Newbury Park: Sage; 1988. p. 31–67.Google Scholar
  29. 29.
    Lee J, Shin C, Ko YH, Lim J, Joe SH, Kim SH, et al. The reliability and validity studies of the Korean version of the perceived stress scale. Korean J Psychosom Med. 2012;20:101–8.CrossRefGoogle Scholar
  30. 30.
    Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010;8(4):348–53.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Sherina MS, Arroll B, Goodyear-Smith F. Criterion validity of the PHQ-9 (Malay version) in a primary care clinic in Malaysia. Med J Malaysia. 2012;67(3):309–15.PubMedGoogle Scholar
  32. 32.
    Santos IS, Tavares BF, Munhoz TN, Almeida LS, Silva NT, Tams BD, et al. Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population. Cad Saude Publica. 2013;29(8):1533–43.PubMedCrossRefGoogle Scholar
  33. 33.
    Park SJ, Choi HR, Choi JH, Kim KW, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety Mood. 2010;6(2):119–24.Google Scholar
  34. 34.
    Lowe B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008;30(3):191–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Kocalevent RD, Hinz A, Brahler E. Standardization of a screening instrument (PHQ-15) for somatization syndromes in the general population. BMC Psychiatr. 2013;13:91.CrossRefGoogle Scholar
  36. 36.
    Del-Ben CM, Machado VF, Madisson MM, Resende TL, Valerio FP, Troncon LE. Relationship between academic performance and affective changes during the first year at medical school. Med Teach. 2013;35(5):404–10.PubMedCrossRefGoogle Scholar
  37. 37.
    Hojat M, Glaser K, Xu G, Veloski JJ, Christian EB. Gender comparisons of medical students’ psychosocial profiles. Med Educ. 1999;33(5):342–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students’ depression at one medical school. Acad Med. 1997;72(6):542–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260(17):2521–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Choi HS, Choi JH, Park KH, Joo KJ, Ga H, Koh HJ, et al. Standardization of the Korean version of Patient Health Questionnaire-9 as a screening instrument for major depressive disorder. J Korean Acad Fam Med. 2007;28:114–9.Google Scholar

Copyright information

© Academic Psychiatry 2014

Authors and Affiliations

  • Seoyoung Yoon
    • 1
  • Yunhwan Lee
    • 1
  • Changsu Han
    • 1
  • Chi-Un Pae
    • 2
    • 3
  • Ho-Kyoung Yoon
    • 1
  • Ashwin A. Patkar
    • 3
  • David C. Steffens
    • 4
  • Yong-Ku Kim
    • 1
  1. 1.Korea University College of MedicineSeoulSouth Korea
  2. 2.The Catholic University College of MedicineSeoulSouth Korea
  3. 3.Duke University Medical CenterDurhamUSA
  4. 4.Department of PsychiatryUniversity of Connecticut School of MedicineFarmingtonUSA

Personalised recommendations