title: Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa.
abstract: Depression is often underdiagnosed and undertreated in primary care settings, particularly in developing countries. This is, in part, due to challenges resulting from lack of skilled mental health workers, stigma associated with mental illness, and lack of cross-culturally validated screening instruments. We conducted this study to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) as a screen for diagnosing major depressive disorder among adults in Ethiopia, the second most populous country in sub-Saharan Africa. A total of 926 adults attending outpatient departments in a major referral hospital in Ethiopia participated in this study. We assessed criterion validity and performance characteristics against an independent, blinded, and psychiatrist administered semi-structured Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. Overall, the PHQ-9 items showed good internal (Cronbach's alpha=0.81) and test re-test reliability (intraclass correlation coefficient=0.92). A factor analysis confirmed a one-factor structure. Receiver Operating Characteristics (ROC) analysis showed that a PHQ-9 threshold score of 10 offered optimal discriminatory power with respect to diagnosis of major depressive disorder via the clinical interview (sensitivity=86% and specificity=67%). The PHQ-9 appears to be a reliable and valid instrument that may be used to diagnose major depressive disorders among Ethiopian adults.
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA. Electronic address: bgelaye@hsph.harvard.edu.
authors: Bizu
authors: B
authors: Gelaye
authors: Michelle A
authors: MA
authors: Williams
authors: Seblewengel
authors: S
authors: Lemma
authors: Negussie
authors: N
authors: Deyessa
authors: Yonas
authors: Y
authors: Bahretibeb
authors: Teshome
authors: T
authors: Shibre
authors: Dawit
authors: D
authors: Wondimagegn
authors: Asnake
authors: A
authors: Lemenhe
authors: Jesse R
authors: JR
authors: Fann
authors: Ann
authors: A
authors: Vander Stoep
authors: Xiao-Hua
authors: XH
authors: Andrew Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005002:Ethiopia / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D014175:Translating; D055815:Young Adult
keywords: Africa; Depression; Ethiopia; PHQ-9; Validation
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