Abstract
Objectives
To compare the measurement properties and responsiveness to change of the Patient
Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist-20 (HSCL-20), and the
Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed
with major depressive disorder (MDD).
Design
Secondary analysis of depression symptoms measured at 6 occasions over 12 weeks as
part of a randomized controlled trial of venlafaxine XR for MDD in persons with SCI.
Setting
Outpatient and community settings.
Participants
Individuals (N=133) consented and completed the drug trial. Eligibility criteria were
age at least 18 years, traumatic SCI, and diagnosis of MDD.
Interventions
Venlafaxine XR.
Main Outcome Measures
Patients completed the PHQ-9 and the HSCL-20 depression scales; clinical investigators
completed the HAM-D and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) Dissociative Disorders, which was used as a diagnostic criterion measure.
Results
All 3 instruments were improved with rating scale analysis. The HSCL-20 and the HAM-D
contained items that misfit the underlying construct and that correlated weakly with
the total scores. Removing these items improved the internal consistency, with floor
effects increasing slightly. The HAM-D correlated most strongly with Structured Clinical
Interview for DSM-IV Dissociative Disorders diagnoses. Improvement in depression was
similar on all outcome measures in both treatment and control groups.
Conclusions
The psychometric properties of the revised depression instruments are more than adequate
for routine use in adults with SCI and are responsive to clinical improvement. The
PHQ-9 is the simplest instrument with measurement properties as good as or better
than those of the other instruments and required the fewest modifications.
Keywords
List of abbreviations:
CGI (Clinical Global Impression), DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition), HAM-D (Hamilton Depression Rating Scale), HSCL-20 (Hopkins Symptom Checklist-20), MDD (major depressive disorder), PGI (Patient Global Impression), PHQ-9 (Patient Health Questionnaire-9), SCI (spinal cord injury), SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Symptoms of major depression in people with spinal cord injury: implications for screening.Arch Phys Med Rehabil. 2004; 85: 1749-1756
- Psychological morbidity and spinal cord injury: a systematic review.Spinal Cord. 2009; 47: 108-114
- Depression following spinal cord injury.Arch Phys Med Rehab. 1996; 77: 816-823
- Enhancing the accuracy of depression diagnosis in patients with spinal-cord injury using Bayesian-analysis.Rehabil Psychol. 1995; 40: 171-180
- Factor structure of the PHQ-9 screen for depression across time since injury among person with spinal cord injury.Rehabil Psychol. 2008; 53: 243-249
- Measuring depression in persons with spinal cord injury: a systematic review.J Spinal Cord Med. 2009; 32: 6-24
- The PHQ-9: validity of a brief depression severity measure.J Gen Int Med. 2001; 16: 606-613
- User’s guide for the structured clinical interview for DSM IV TR Axis I disorders, research version.Biometrics Research Dept, New York State Psychiatric Institute, New York2001
- Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation.Arch Phys Med Rehabil. 2012; 93: 1838-1845
- Treatment of depression following spinal cord injury: an evidence-based review.Rehabil Psychol. 2004; 49: 134-139
- A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: methods and lessons learned.J Spinal Cord Med. 2014; 37: 247-263
- Venlafaxine extended-release for depression following spinal cord injury: a randomized clinical trial.JAMA Psychiatry. 2015; 72: 247-258
- A rating scale for depression.J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
- Collaborative management to achieve treatment guidelines: impact on depression in primary care.JAMA. 1995; 273: 1026-1031
- The HSCL-20: one questionnaire, two versions.J Psychosom Res. 2010; 68: 313-314
- ECDEU assessment manual for psychopharmacology—revised (DHEW Publication No. ADM 76-338).U.S. Dept of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, Rockville1976: 218-222
- Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9).J Affect Disord. 2004; 81: 61-66
- Monitoring depression treatment outcomes with the Patient Health Questionnaire-9.Med Care. 2004; 42: 1194-1201
- Diagnosing ICD-10 depressive episodes: superior criterion validity of the Patient Health Questionnaire.Psychother Psychosom. 2004; 73: 386-390
- The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a cross-sectional study.BMC Fam Pract. 2010; 11: 98
- Validity of the brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population.Gen Hosp Psychiatry. 2006; 28: 71-77
- Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review.Nord J Psychiatry. 2015; 69: 497-508
- Validity of the Hospital Anxiety And Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease.Gen Hosp Psychiatry. 2007; 29: 417-424
- Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis.J Gen Intern Med. 2007; 22: 1596-1602
- Responsiveness of the PHQ-9 to psychopharmacological depression treatment.Psychosomatics. 2006; 47: 62-67
- PHQ-9: sensitivity to change over time.Br J Gen Pract. 2010; 60: 535-536
- Improving the efficiency of screening for major depression in people with spinal cord injury.J Spinal Cord Med. 2008; 31: 177-184
- Improving measurement properties of the Patient Health Questionnaire-9 with rating scale analysis.Rehabil Psychol. 2009; 54: 198-203
- The Hopkins Symptom Checklist (HSCL): factors derived from the HSCL-90.J Affect Disord. 1979; 1: 9-24
- Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults.JAMA. 2000; 284: 1519-1526
- Present use of the Hamilton Depression Rating Scale: observation on method of assessment in research of depressive disorders.Br J Psychiatry. 1996; 168: 594-597
- Standardizing the Hamilton Depression Rating Scale: past, present, and future.Eur Arch Psychiatry Clin Neurosci. 2001; 251: II6-II12
- Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as screening instruments for depression in stroke patients.Psychosomatics. 2002; 43: 386-393
- Validity of Hamilton Depression Inventory in Parkinson’s disease.Mov Disord. 2007; 22: 399-403
- Depression following spinal cord injury: a prospective in-patient study.Br J Psychiatry. 1989; 154: 668-671
- The Hamilton Depression Rating Scale: has the gold standard become a lead weight?.Am J Psychiatry. 2004; 161: 2163-2177
- The responsiveness of the Hamilton Depression Rating Scale.J Psychiatr Res. 2000; 34: 3-10
- Improving the assessment of severity of depressive states: a reduction of the Hamilton Depression Scale.Pharmacopsychiatry. 1985; 18: 114-115
- Quantitative rating of depressive states.Acta Psychiatr Scand. 1975; 51: 161-170
- Diagnostic and statistical manual of mental disorders, fourth edition, text revision.American Psychiatric Association, Washington, DC2000
- Winsteps®. Winsteps.com, Beaverton2014
- A rating formulation for ordered response categories.Psychometrika. 1978; 43: 561-573
- Rasch model for partial credit scoring.Psychometrika. 1982; 47: 149-174
- Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence.Arch Gen Psychiatry. 1991; 48: 851-855
- Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission.J Clin Psychiatry. 2009; 70: 26-31
Article info
Publication history
Published online: February 06, 2016
Footnotes
Supported by the Department of Education, National Institute on Disability and Rehabilitation Research (grant nos. H133A060107 and H133N110009) and by Pfizer Pharmaceuticals in the form of study drug (protocol no. 0600B1-4439).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
