Abstract
Bombardier CH, Kalpakjian CZ, Graves DE, Dyer JR, Tate DG, Fann JR. Validity of the
Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient
spinal cord injury rehabilitation.
Objective
To investigate the validity of the Patient Health Questionnaire-9 (PHQ-9) depression
screening measure in people undergoing acute inpatient rehabilitation for spinal cord
injury (SCI).
Design
We performed a blinded comparison of the PHQ-9 administered by research staff with
the major depression module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) conducted by a mental health professional.
Setting
Inpatient rehabilitation units.
Participants
Participants (N=142) were patients undergoing acute rehabilitation for traumatic SCI
who were at least 18 years of age, English speakers, and without severe cognitive,
motor speech, or psychotic disorders. We obtained the SCID on 173 (84%) of 204 eligible
patients. The final sample of 142 patients (69%) consisted of those who underwent
both assessments within 7 days of each other.
Interventions
Not applicable.
Main Outcome Measures
PHQ-9 and SCID major depression module.
Results
Participants were on average 42.2 years of age, 78.2% men, and 81.7% white, and 66.9%
had cervical injuries. The optimal PHQ-9 cutoff (≥11) resulted in 35 positive screens
(24.6%). Key indices of criterion validity were as follows: sensitivity, 1.00 (95%
confidence interval [CI], .73–1.00); specificity, .84 (95% CI, .76–.89); Youden Index,
.84; positive predictive value, .40 (95% CI, .24–.58); and negative predictive value,
1.00 (95% CI, .96–1.00). The area under the receiver operator curve was .92, and κ
was .50. Total PHQ-9 scores were inversely correlated with subjective health state
and quality of life since SCI.
Conclusions
The PHQ-9 meets criteria for good diagnostic accuracy compared with a structured diagnostic
assessment for major depressive disorder even in the context of inpatient rehabilitation
for acute traumatic SCI.
Key Words
List of Abbreviations:
DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), MDD (major depressive disorder), PHQ-2 (Patient Health Questionnaire-2), PHQ-9 (Patient Health Questionnaire-9), SCI (spinal cord injury), SCID (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), SF-1 (Medical Outcomes Study Short Form-1), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 02, 2012
Footnotes
Reprints are not available from the author.
Supported by the Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington (grant no. H133N060033), Baylor College of Medicine (grant no. H133N060003), and University of Michigan (grant no. H133N060032).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Jun 9, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
