title: Lower PHQ-9 cutpoint accurately diagnosed depression in people with long-term conditions attending the Accident and Emergency Department.
abstract: BACKGROUND
  Major Depressive Disorder (MDD) is frequent in the Accident and Emergency Department (AED) but is often unrecognized. We aimed to assess the prevalence of MDD and determine the psychometric properties of the PHQ-9 in diagnosing MDD in patients with long-term medical conditions attending an AED.
  
  
  METHODS
  The PHQ-9 was administered to 349 patients with diabetes, COPD and chronic inflammatory rheumatic diseases, mainly rheumatoid arthritis and spondyloarthropathies, visiting an AED. The MINI interview was used as the criterion standard for MDD. Receiver operator characteristic (ROC) curve analysis was performed to determine the optimal PHQ-9 cutpoint for MDD. Construct validators included psychological distress (SCL-90-R), illness perceptions (B-IPQ) and Health-Related Quality of Life (WHOQOL-BREF).
  
  
  RESULTS
  The prevalence of MDD was 27.2%. At an optimal cutpoint of 8, PHQ-9 had a sensitivity of 90.5% and specificity of 89.4%. The area under the curve (0.96) was excellent. Convergent validity was established by the strong associations between PHQ-9 scores and functional status, SCL-90-R depression, illness perceptions and AED visits during the previous year.
  
  
  CONCLUSIONS
  The sample consisted of multiple rather a single disease group, preventing us from accounting for illness severity using specific disease severity indices.
  
  
  CONCLUSIONS
  MDD is frequent in patients with long-term medical conditions attending the AED and the PHQ-9, at a cutpoint of 8, is an accurate, reliable and valid measure for MDD screening in this patient population.
authors.affiliation: Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece. Electronic address: tyfantis@cc.uoi.gr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hyphantis
authors.affiliation: Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kotsis
authors.affiliation: Regenstrief Institute for Health Care and Department of Medicine, Indiana University, USA.
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
authors.affiliation: Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Paika
authors.affiliation: Department of Pulmonary Medicine, Medical School, University of Ioannina, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Constantopoulos
authors.affiliation: Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Greece.
authors.forename: Alexandros A
authors.initials: AA
authors.lastname: Drosos
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Guthrie
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012216:Rheumatic Diseases / Q000453:epidemiology*; D012720:Severity of Illness Index
keywords: COPD; Depression; Diabetes; Emergency Department; Screening