title: How do the PHQ-2, the PHQ-9 perform in aging services clients with cognitive impairment?
abstract: OBJECTIVE
  To examine the performance of the Patient Health Questionnaire-2 (PHQ-2) and the PHQ-9 in detecting current major depressive episode (MDE) in aging services care management clients who screen positive for cognitive impairment (CI).
  
  
  METHODS
  Cross-sectional observational study of 236 care management clients ages ≥60 years recruited from an Upstate NY aging services agency. The test characteristics of the PHQ-2 and PHQ-9 to screen for depression were calculated using the Structured Clinical Interview for DSM-IV (SCID) to identify MDE (gold standard). CI was identified with the Six-Item Screen (SIS).
  
  
  RESULTS
  Participants had a mean age of 77 years, 68% female, 16% non-white, and 26% had less than a high school education. 16% of participants had CI identified by ≥2 errors on SIS. Of these, 41% had positive PHQ-2 (scores ≥3), 43% had positive PHQ-9 (scores ≥10), while 24% met criteria for MDE. In the sample with CI, the PHQ-2, using a cutoff of 3, had sensitivity = 0.78, specificity = 0.71, and receiver operating characteristic (ROC) area under the curve (AUC) = 0.81, compared with 0.79, 0.82, and 0.88, respectively, for those without CI. In the sample with CI, the PHQ-9, using a cutoff of 10, had sensitivity = 0.89, specificity = 0.71, and AUC = 0.85, compared with 0.85, 0.89, and 0.91, respectively, for those without CI.
  
  
  CONCLUSIONS
  Cognitive status should be considered when using the PHQ as a depression screener due to poorer specificity in seniors with CI.
authors.affiliation: Department of Psychiatry, University of Rochester School of Medicine and Dentistry, New York, USA. lisa_boyle@urmc.rochester.edu
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Boyle
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Richardson
authors.forename: Hua
authors.initials: H
authors.lastname: He
authors.forename: Yinglin
authors.initials: Y
authors.lastname: Xia
authors.forename: Xin
authors.initials: X
authors.lastname: Tu
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000523:psychology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*