Measuring depression severity in general practice: discriminatory performance of the PHQ-9, HADS-D, and BDI-II.
نویسندگان
چکیده
BACKGROUND The UK Quality and Outcomes Framework (QOF) rewards practices for measuring symptom severity in patients with depression, but the endorsed scales have not been comprehensively validated for this purpose. AIM To assess the discriminatory performance of the QOF depression severity measures. DESIGN AND SETTING Psychometric assessment in nine Scottish general practices. METHOD Adult primary care patients diagnosed with depression were invited to participate. The HADS-D, PHQ-9, and BDI-II were assessed against the HRSD-17 interview. Discriminatory performance was determined relative to the HRSD-17 cut-offs for symptoms of at least moderate severity, as per criteria set by the American Psychiatric Association (APA) and NICE. Receiver operating characteristic curves were plotted and area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) calculated. RESULTS A total of 267 were recruited per protocol, mean age = 49.8 years (standard deviation [SD] = 14.1), 70% female, mean HRSD-17=12.6 (SD = 7.62, range = 0-34). For APA criteria, AUCs were: HADS-D = 0.84; PHQ-9 = 0.90; and BDI-II = 0.86. Optimal sensitivity and specificity were reached where HADS-D ≥9 (74%, 76%); PHQ-9 ≥12 (77%, 79%), and BDI-II ≥23 (74%, 75%). For NICE criteria: HADS-D AUC = 0.89; PHQ-9 AUC = 0.93; and BDI-II AUC = 0.90. Optimal sensitivity and specificity were reached where HADS-D ≥10 (82%, 75%), PHQ-9 ≥15 (89%, 83%), and BDI-II ≥28 (83%, 80%). LRs did not provide evidence of sufficient accuracy for clinical use. CONCLUSION As selecting treatment according to depression severity is informed by an evidence base derived from trials using HRSD-17, and none of the measures tested aligned adequately with that tool, they are inappropriate for use.
منابع مشابه
Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care.
BACKGROUND The 2004 National Institute for Health and Clinical Excellence (NICE) guidelines highlight the importance of assessing severity of depression in primary care. AIM To assess the psychometric properties of the Patient Health Questionnaire (PHQ-9) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) for measuring depression severity in primary care. DESI...
متن کاملComparison of two self-rating scales to detect depression: HADS and PHQ-9.
BACKGROUND More than half of patients with depression go undetected. Self-rating scales can be useful in screening for depression, and measuring severity and treatment outcome. AIM This study compares the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) with regard to their psychometric properties, and investigates their agreement at different cut-off ...
متن کاملManagement of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data.
OBJECTIVE To determine if general practitioner rates of antidepressant drug prescribing and referrals to specialist services for depression vary in line with patients' scores on depression severity questionnaires. DESIGN Analysis of anonymised medical record data. SETTING 38 general practices in three sites-Southampton, Liverpool, and Norfolk. Data reviewed Records for 2294 patients assesse...
متن کاملIdentification of depression in diabetes: the efficacy of PHQ-9 and HADS-D.
BACKGROUND Clinical guidelines advise screening for depression in patients with diabetes. The Patient Health Questionnaire (PHQ-9) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) are commonly used in primary care. AIM To compare the efficacy of HADS-D and PHQ-9 in identifying moderate to severe depression among primary care patients with type 2 diabetes. DE...
متن کاملDetecting Depression in Patients with Coronary Heart Disease: a Diagnostic Evaluation of the PHQ-9 and HADS-D in Primary Care, Findings From the UPBEAT-UK Study
OBJECTIVE People with coronary heart disease (CHD) are at heightened risk of depression, and this co-occurrence of conditions is associated with poorer outcomes including raised mortality. This study compares the diagnostic accuracy of two depression case finding instruments in CHD patients relative to a diagnostic standard, the revised Clinical Interview Schedule (CIS-R). METHODS The Patient...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- The British journal of general practice : the journal of the Royal College of General Practitioners
دوره 61 588 شماره
صفحات -
تاریخ انتشار 2011