title: Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy.
abstract: OBJECTIVE
  This study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy.
  
  
  METHODS
  Tertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a "gold standard" instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy.
  
  
  RESULTS
  The calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but not different from the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864).
  
  
  CONCLUSIONS
  The PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.
authors: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Neurology and Rehabilitation, Neuropsychiatric Institute, University of Illinois Medical Center at Chicago (UIC), IL, USA. Electronic address: neurocare9@gmail.com.
authors: Jaivir S
authors: JS
authors: Rathore
authors: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: JEHIL@ccf.org.
authors: Lara E
authors: LE
authors: Jehi
authors: Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: FanY2@ccf.org.
authors: Youran
authors: Y
authors: Fan
authors: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; MINCEP Epilepsy Care, University of Minnesota Medical Center, Minneapolis, MN, USA. Electronic address: sipatel12@gmail.com.
authors: Sima I
authors: SI
authors: Patel
authors: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: foldvan@ccf.org.
authors: Nancy
authors: N
authors: Foldvary-Schaefer
authors: Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Psychology Services, Tampa General Hospital, Tampa, FL, USA. Electronic address: maya.ramirez@gmail.com.
authors: Maya J
authors: MJ
authors: Ramirez
authors: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: buschr@ccf.org.
authors: Robyn M
authors: RM
authors: Busch
authors: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: obuchon@ccf.org.
authors: Nancy A
authors: NA
authors: Obuchowski
authors: Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: TESARG@ccf.org.
authors: George E
authors: GE
authors: Tesar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D004827:Epilepsy / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology / Q000523:psychology; D009422:Nervous System Diseases / Q000150:complications / Q000523:psychology; D009483:Neuropsychological Tests; D012015:Reference Standards; D015203:Reproducibility of Results; D018570:Risk Assessment; D013405:Suicide / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Depression; Epilepsy/seizures; Mini-International Neuropsychiatric Interview (MINI); NDDI-E; PHQ-9