title: Sensitivity and specificity of clinician administered screening instruments in detecting depression among HIV-positive individuals in Uganda.
abstract: Depressive disorders are highly prevalent in Africa where diseases such as HIV/AIDS are common. The aim of this study was to assess the validity of commonly used depression screening instruments in a setting characterized by low literacy, where patients may not be able to self-administer depression scales. We explored the validity of the Patient Health Questionaire-9 (PHQ-9), Centre for Epidemiological Surveys for Depression (CES-D), and the Kessler-10 (K-10), using the Mini International Neuropsychiatric Instrument (MINI) as a gold standard in 368 persons living with HIV/AIDS (PLWHA) in Uganda. The shorter versions of the K-10 and PHQ-9 were extracted to assess their performance in comparison to the longer versions. We used STATA 11.2 to analyze the data. The prevalence of a MINI defined depression in this patient sample was 17.4%. The three instruments all performed well, with areas under the curve (AUC) ranging from 0.82 to 0.96. The PHQ-9 showed the best performance characteristics with an AUC of 0.96, a sensitivity of 91.6%, and specificity 81.2%. The extracted versions performed more modestly. All three instruments showed good properties as screening tools; the PHQ-9 has particularly high sensitivity and specificity, and so can be considered useful for screening HIV-positive patients for depression.
authors: a Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.
authors: Dickens
authors: D
authors: Akena
authors: John
authors: J
authors: Joska
authors: Ekwaro A
authors: EA
authors: Obuku
authors: Dan J
authors: DJ
authors: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000592:standards; D015203:Reproducibility of Results; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology