Advertisement

Assessing depression in primary care with the PHQ-9: Can it be carried out over the telephone?

  • Alejandra Pinto-Meza
  • Antoni Serrano-Blanco
  • Maria T. Peñarrubia
  • Elena Blanco
  • Josep Maria Haro
Original Articles

Abstract

BACKGROUND: Telephone assessment of depression for research purposes is increasingly being used. The Patient Health Questionnaire 9-item depression module (PHQ-9) is a well-validated, brief, self-reported, diagnostic, and severity measure of depression designed for use in primary care (PC). To our knowledge, there are no available data regarding its validity when administered over the telephone.

OBJECTIVE: The aims of the present study were to evaluate agreement between self-administered and telephone-administered PHQ-9, to investigate possible systematic bias, and to evaluate the internal consistency of the telephone-administered PHQ-9.

METHODS: Three hundred and forty-six participants from two PC centers were assessed twice with the PHQ-9. Participants were divided into 4 groups according to administration procedure order and administration procedure of the PHQ-9: Self-administered/Telephone-administered; Telephone-administered/Self-administered; Telephone-administered/Telephone-administered; and Self-administered/Self-administered. The first 2 groups served for analyzing the procedural validity of telephone-administered PHQ-9. The last 2 allowed a test-retest reliability analysis of both self- and telephone-administered PHQ-9. Intraclass correlation coefficient (ICC) and weighted κ (for each item) were calculated as measures of concordance. Additionally, Pearson’s correlation coefficient, Student’s t-test, and Cronbach’s α were analyzed.

RESULTS: Intraclass correlation coefficient and weighted κ between both administration procedures were excellent, revealing a strong concordance between telephone- and self-administered PHQ-9. A small and clinically nonsignificant tendency was observed toward lower scores for the telephone-administered PHQ-9. The internal consistency of the telephone-administered PHQ-9 was high and close to the self-administered one.

CONCLUSIONS: Telephone and in-person assessments by means of the PHQ-9 yield similar results. Thus, telephone administration of the PHQ-9 seems to be a reliable procedure for assessing depression in PC.

Key words

PHQ-9 telephone assessment depression primary care 

References

  1. 1.
    World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Survey. JAMA. 2004;291:2581–90.CrossRefGoogle Scholar
  2. 2.
    Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto US mental and addictive disorders service system. Arch Gen Psychiatr. 1993;50:85–94.PubMedGoogle Scholar
  3. 3.
    Narrow WE, Regier DA, Rae DS, Manderscheid RW, Locke BZ. Use of services by persons with mental and addictive disorders. Arch Gen Psychiatr. 1993;50:95–107.PubMedGoogle Scholar
  4. 4.
    Murlow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913–21.Google Scholar
  5. 5.
    Williams JW, Noël PH, Cordes JA, Ramirez G, Pignone M. Is this patient clinically depressed? JAMA 287:1160–70.Google Scholar
  6. 6.
    McDowell I, Kristjansson E, Newell C. Depression. In: McDowell I, Newell C., eds. Measuring Health: A Guide to Rating Scales and Questionnaires. 2nd edn. New York, NY: Oxford University Press; 1996:238–86.Google Scholar
  7. 7.
    Spitzer RL, Kroenke K, Williams JB. Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of the PRIME-MD: the PHQ primary care study. JAMA. 1999;282:1737–44.PubMedCrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR 4th edn Text Revision. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  9. 9.
    Diez-Quevedo C, Rangil T, Sanchez-Planell L, Kroenke K, Spitzer RL. Validation and utility of the Patient Health Questionnaire in diagnosing mental disorders in 1003 general hospital Spanish impatients. Psychosom Med. 2001;63:679–86.PubMedGoogle Scholar
  10. 10.
    Gräfe K, Zipfel S, Herzog W, Löwe B. Screening for psychiatric disorders with the Patient Health Questionnaire (PHQ). Results from the German validation study. Diagnostica. 2004;50:171–81.CrossRefGoogle Scholar
  11. 11.
    Becker S, Al Zaid K, Al Faris E. Screening for somatization and depression in Saudi Arabia: a validation study of the PHQ in primary care. Int J Psychiatr Med. 2002;32:271–83.CrossRefGoogle Scholar
  12. 12.
    Kroenke K, Spitzer RL, Williams JBW. The PHQ-9 validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.PubMedCrossRefGoogle Scholar
  13. 13.
    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;4:191–5.Google Scholar
  14. 14.
    Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disorders. 2004;81:61–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Löwe B, Spitzer RL, Gräfe K, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disorders. 2004;81:61–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Spitzer RL, Williams JB. Clasificación de los transtornos mentales [Classification of mental disorders]. In: Kaplan HI, Sakock BJ, eds. Tratado de psiquiatría [Comprehensive Textbook of Psychiatry]. 2nd edn. Barcelona, Spain: Salvat; 1989:585–607.Google Scholar
  17. 17.
    Simon GE, Revicki D, VonKorff M. Telephone assessment of depression severity. J Psychiatr Res. 1993;27:247–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Aneshensel CS, Frerichs RR, Clark VA, Yocopenic PA. Measuring depression in the community: a comparison of telephone and personal interviews. Public Opin Q. 1982;46:110–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Doménech JM. Fundamentos de diseño y estadística. UD 14: Medida del cambio: Análisis de diseños con medidas intrasujeto [Statistics and Design Basis. UD 14: Change Measures: Intra-Subject Measure Design Analysis]. Barcelona, Spain: Signo; 2002.Google Scholar
  20. 20.
    Helzer JE, Robins LN, McEvoy LT, et al. A comparison of clinical and diagnostic interview schedule diagnosis. Physician reexamination of lay-interviewed cases in the general population. Arch Gen Psychiatr. 1985;42:657–66.PubMedGoogle Scholar
  21. 21.
    Evans M, Kessler D, Lewis G, Peters TJ, Sharp D. Assessing mental health in primary care research using standardized scales: can it be carried out over the telephone? Psychol Med. 2004;34:157–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Rohde P, Lewinsohn PM, Seeley JR. Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. Am J Psychiatr. 1997;154:1593–8.PubMedGoogle Scholar
  23. 23.
    Fenig S, Levav I, Kohn R, Yelin N. Telephone vs face-to-face interviewing in a community psychiatric survey. Am J Public Health. 1993;83:896–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Jorm AF, Duncan-Jones P, Scott R. An analysis of the re-test artifact in longitudinal studies of psychiatric symptoms and personality. Psychol Med. 1989;19:487–93.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Alejandra Pinto-Meza
    • 1
  • Antoni Serrano-Blanco
    • 1
  • Maria T. Peñarrubia
    • 2
  • Elena Blanco
    • 2
  • Josep Maria Haro
    • 1
  1. 1.Research and Development UnitSant Joan de Déu-SSMBarcelonaSpain
  2. 2.Primary Care Health Center Gavà II, Costa de Ponent’s Teaching Unit, Catalan Health ServiceCataloniaSpain

Personalised recommendations