title: Making the cut: Depression screening in urban general hospital clinics for culturally diverse Latino populations.
abstract: We examined whether the cut-point 10 for the Patient Health Questionnaire-9 (PHQ9) depression screen used in primary care populations is equally valid for Mexicans (M), Ecuadorians (E), Puerto Ricans (PR) and non-Hispanic whites (W) from inner-city hospital-based primary care clinics; and whether stressful life events elevate scores and the probability of major depressive disorder (MDD).
  
  
  
  Over 18-months, a sample of persons from hospital clinics with a positive initial PHQ2 and a subsequent PHQ9 were administered a stressful life event questionnaire and a Structured Clinical Interview to establish an MDD diagnosis, with oversampling of those between 8 and 12: (n=261: 75 E, 71 M, 51 PR, 64 W). For analysis, the sample was weighted using chart review (n=368) to represent a typical clinic population. Receiver Operating Characteristics analysis selected cut-points maximizing sensitivity (Sn) plus specificity (Sp).
  
  
  
  The optimal cut-point for all groups was 13 with the corresponding Sn and Sp estimates for E=(Sn 73%, Sp 71%), M=(76%, 81%), PR=(81%, 63%) and W=(80%, 74%). Stressful life events impacted screen scores and MDD diagnosis.
  
  
  
  Elevating the PHQ9 cut-point for inner-city Latinos as well as whites is suggested to avoid high false positive rates leading to improper treatment with clinical and economic consequences.
authors.affiliation: Montefiore Hudson Valley Collaborative, 3 Executive Boulevard, Yonkers, NY 10701, United States. Electronic address: dgutnick@montefiore.org.
authors.forename: Damara
authors.initials: D
authors.lastname: Gutnick
authors.affiliation: Langone School of Medicine, New York University Department of Psychiatry, One Park Avenue, New York, NY 10016, United States. Electronic address: carole.siegel@nyumc.org.
authors.forename: Carole
authors.initials: C
authors.lastname: Siegel
authors.affiliation: Langone School of Medicine, New York University Department of Psychiatry, One Park Avenue, New York, NY 10016, United States. Electronic address: laskae01@nyumc.org.
authors.forename: Eugene
authors.initials: E
authors.lastname: Laska
authors.affiliation: Nathan Kline Institute for Psychiatric Research, 140, Old Orangeburg Rd., Orangeburg, NY 10962, United States. Electronic address: joewash@earthlink.net.
authors.forename: Joseph
authors.initials: J
authors.lastname: Wanderling
authors.affiliation: Adolescent Health Initiative, University of Michigan, 2025 Traverwood Drive, Ann Arbor, MI 48105, United States. Electronic address: ellencogenwagner@gmail.com.
authors.forename: Ellen Cogen
authors.initials: EC
authors.lastname: Wagner
authors.affiliation: Nathan Kline Institute for Psychiatric Research, 140, Old Orangeburg Rd., Orangeburg, NY 10962, United States. Electronic address: hauglandg@aol.com.
authors.forename: Gary
authors.initials: G
authors.lastname: Haugland
authors.affiliation: Langone School of Medicine, New York University Department of Child and Adolescent Psychiatry, One Park Avenue, New York, NY 10016, United States. Electronic address: mollycon@gmail.com.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Conlon
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000208:ethnology*; D004484:Ecuador / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D009519:New York City / Q000208:ethnology; D000073222:Patient Health Questionnaire / Q000592:standards*; D011647:Puerto Rico / Q000208:ethnology; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000208:ethnology*
keywords: Depression screening; Immigrant health; Latinos