Patient Health Questionnaire-9 as an Effective Tool for Screening of Depression Among Indian Adolescents

• Published in: Journal of adolescent health 2013-05, Vol.52 (5), p.546-551
• Main Authors: Ganguly, Samrat, M.D, Samanta, Moumita, M.D, Roy, Prithwish, M.D, Chatterjee, Sukanta, M.D, Kaplan, David W., M.D., M.P.H, Basu, Bharati, Ph.D., M.Sc
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Adult and adolescent clinical studies; Area Under Curve; Biological and medical sciences; Depression; Depression - diagnosis; Depression - epidemiology; Diagnosis; Female; Health; Humans; India; India - epidemiology; Interview, Psychological; Male; Mass Screening; Medical sciences; Mood disorders; Paediatricians; Patient Health Questionnaire–9; Pediatrics; Primary care; Primary Health Care; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Reliability; Reproducibility of Results; ROC Curve; Screening; Sensitivity and Specificity; Surveys and Questionnaires; Techniques and methods; Validity
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2012.09.012

Abstract Purpose Detection of depression among adolescents in the primary care setting is of paramount importance, especially in resource-constrained countries such as India. This article discusses the diagnostic accuracy, reliability, and validity of the Patient Health Questionnaire–9 (PHQ-9) when pediatricians use it among Indian adolescents. Methods Pediatricians administered the PHQ-9 to 233 adolescent students aged 14–18 years, along with the Beck Depression Inventory. Our psychologist clinically diagnosed depression based on an International Classification of Diseases, 10th Revision, interview of participants. One month later, the PHQ-9 was readministered among students. We conducted appropriate analyses for validity and diagnostic accuracy. Results A total of 31 students (13.3%) had a form of depression on psychiatric interview. A PHQ-9 score of ≥5 was ideal for screening (sensitivity, 87.1%; specificity, 79.7%). In addition to good content validity, PHQ-9 had good 1-month test–retest reliability (r = .875) and internal consistency (Cronbach's α = .835). There was high convergent validity with the Beck Depression Inventory (r = .76; p  = .001). The concordance rate between the PHQ-9 threshold score of ≥10 and the International Classification of Diseases, 10th Revision based diagnosis was good (Cohen's κ = .62). The area under the receiver operating characteristic curve for PHQ-9 was .939. Conclusions The PHQ-9 is a psychometrically sound screening tool for use by pediatricians in a primary care setting in India. Because it is a short, simple, easy to administer questionnaire, the PHQ-9 has tremendous potential in helping to tackle the growing problem of depression among adolescents in developing countries.