Measuring depressive symptoms using the Patient Health Questionnaire-9 in Hong Kong Chinese subjects with type 2 diabetes.
BACKGROUND
Depression is common in type 2 diabetes although the prevalence in Chinese patients remains unclear. We validated the Patient Health Questionnaire(PHQ-9), a popular depression screening tool, in Chinese with type 2 diabetes, and documented the prevalence, demographic,and clinical characteristics associated with depression.


METHODS
A consecutive cohort of 586 Hong Kong Chinese outpatients completed the PHQ-9 during comprehensive diabetes complication assessment. Within 2-4 weeks, 40 patients were retested via telephone survey. Ninety-nine randomly selected patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview as a golden standard. Receiver operating characteristic curve was used to assess performance of the PHQ-9.


RESULTS
The internal consistency of the PHQ-9 was 0.86 and test-retest reliability was 0.70. The 3 somatic items explained 53.6% of the PHQ-9 score. The optimal cutoff value was 7 with 82.6% sensitivity and 73.7% specificity, giving a depression prevalence of 18.3% (n=107). Of these, 18.7% had been previously diagnosed with depression. Depression was more prevalent in women than men. After controlling for confounders, patients with depression had higher HbA1c (7.80 ± 1.86% versus 7.43 ± 1.29%, [61.7 ± 20.4 versus 57.8 ± 14.1 mmol/mol], P<0.05), reduced likelihood of achieving HbA1c target of <7.0% (33.6% versus 41.8%, P<0.05), and were more likely to have self-reported hypoglycemia in the previous 3 months (18.7% versus 6.7%, P<0.01).


CONCLUSIONS
A small sample was used in the criterion validation and the cross-sectional design precludes causal inference.


CONCLUSIONS
PHQ-9 is a validated tool for screening for depression, which is common and frequently undiagnosed in Chinese type 2 diabetic patients and is associated with suboptimal glycemic control, hypoglycemia, and somatization.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
Yuying
Y
Zhang
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
Rose
R
Ting
Department of Psychiatry, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
Marco
M
Lam
Department of Psychiatry, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
Joyce
J
Lam
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
Hairong
H
Nan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Division of Endocrinology, University of British Columbia, Canada.
Roseanne
R
Yeung
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
Wenying
W
Yang
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
Linong
L
Ji
Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Jianping
J
Weng
Department of Psychiatry, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region.
Yun-Kwok
YK
Wing
Association for the Improvement of Mental Health Programmes, Geneva, Switzerland.
Norman
N
Sartorius
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region. Electronic address: jchan@cuhk.edu.hk.
Juliana C N
JCN
Chan
D000368:Aged; D044466:Asian People; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D015995:Prevalence; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
Chinese; Depression; Glycemic control; Patient Health Questionnaire-9; Somatization; Type 2 diabetes