Screening for Major Depressive Disorder with the Patient Health Questionnaire (PHQ-9 and PHQ-2) in an Outpatient Clinic Staffed by Primary Care Physicians in Japan: A Case Control Study
The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 a...
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Published in | PloS one Vol. 10; no. 3; p. e0119147 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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19.03.2015
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Abstract | The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan.
New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR.
Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores.
The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan. |
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AbstractList | The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan.New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR.Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores.The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan. Objective The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8–11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan. Methods New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR. Results Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores. Conclusion The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan. The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan. New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR. Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores. The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan. The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with [greater than or equal to]8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan. New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR. Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were [greater than or equal to]11 (sensitivity 0.76, specificity 0.81) and [greater than or equal to]3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores. The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be [greater than or equal to]11 to detect depression in the primary care setting in Japan. Objective The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with [greater than or equal to]8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan. Methods New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR. Results Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were [greater than or equal to]11 (sensitivity 0.76, specificity 0.81) and [greater than or equal to]3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores. Conclusion The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be [greater than or equal to]11 to detect depression in the primary care setting in Japan. Objective The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8–11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan. Methods New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR. Results Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores. Conclusion The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan. The Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan.OBJECTIVEThe Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8-11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan.New consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR.METHODSNew consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR.Forty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores.RESULTSForty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores.The PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan.CONCLUSIONThe PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan. |
Audience | Academic |
Author | Suzuki, Keiko Ohhira, Masumi Kumei, Shima Okumura, Toshikatsu Nozu, Tsukasa |
AuthorAffiliation | 2 Department of General Internal Medicine, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan 3 Department of Regional Medicine and Education, Asahikawa University Hospital, Asahikawa, Hokkaido, Japan University of Iowa Hospitals & Clinics, UNITED STATES 1 Department of General Medicine, Asahikawa University Hospital, Asahikawa, Hokkaido, Japan |
AuthorAffiliation_xml | – name: University of Iowa Hospitals & Clinics, UNITED STATES – name: 1 Department of General Medicine, Asahikawa University Hospital, Asahikawa, Hokkaido, Japan – name: 3 Department of Regional Medicine and Education, Asahikawa University Hospital, Asahikawa, Hokkaido, Japan – name: 2 Department of General Internal Medicine, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan |
Author_xml | – sequence: 1 givenname: Keiko surname: Suzuki fullname: Suzuki, Keiko – sequence: 2 givenname: Shima surname: Kumei fullname: Kumei, Shima – sequence: 3 givenname: Masumi surname: Ohhira fullname: Ohhira, Masumi – sequence: 4 givenname: Tsukasa surname: Nozu fullname: Nozu, Tsukasa – sequence: 5 givenname: Toshikatsu surname: Okumura fullname: Okumura, Toshikatsu |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25789476$$D View this record in MEDLINE/PubMed |
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Copyright | COPYRIGHT 2015 Public Library of Science 2015 Suzuki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2015 Suzuki et al 2015 Suzuki et al |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Conceived and designed the experiments: KS TO. Performed the experiments: KS SK MO TN TO. Analyzed the data: KS TO. Contributed reagents/materials/analysis tools: KS TO. Wrote the paper: KS TO. |
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References_xml | – volume: 30 start-page: 38 year: 1996 ident: ref2 article-title: Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care publication-title: Br J Psychiatry Suppl doi: 10.1192/S0007125000298395 – volume: 22 start-page: 1596 issue: 11 year: 2007 ident: ref12 article-title: Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis publication-title: J Gen Intern Med doi: 10.1007/s11606-007-0333-y – ident: ref4 – volume: 7 start-page: 167 issue: 4 year: 2005 ident: ref3 article-title: The importance of somatic symptoms in depression in primary care publication-title: Prim Care Companion J Clin Psychiatry doi: 10.4088/PCC.v07n0405 – volume: 8 start-page: 348 issue: 4 year: 2010 ident: ref6 article-title: Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population publication-title: Ann Fam Med doi: 10.1370/afm.1139 – volume: 59 start-page: 517 issue: 5 year: 2005 ident: ref11 article-title: Reliability and validity of Japanese version of the Mini-International Neuropsychiatric Interview publication-title: Psychiatry Clin Neurosci doi: 10.1111/j.1440-1819.2005.01408.x – volume: 12 start-page: 73 year: 2012 ident: ref9 article-title: Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care publication-title: BMC Psychiatry doi: 10.1186/1471-244X-12-73 – volume: 35 start-page: 592 issue: 6 year: 2013 ident: ref8 article-title: Validity of the Patient Health Questionnaire (PHQ)-9 and PHQ-2 in general internal medicine primary care at a Japanese rural hospital: a cross-sectional study publication-title: Gen Hosp Psychiatry doi: 10.1016/j.genhosppsych.2013.08.001 – volume: 24 start-page: 328 issue: 5 year: 2002 ident: ref1 article-title: LIDO Group. Course of depression, health services costs, and work productivity in an international primary care study publication-title: Gen Hosp Psychiatry doi: 10.1016/S0163-8343(02)00201-3 – volume: 58 start-page: 163 issue: 2 year: 2005 ident: ref13 article-title: Detecting and monitoring depression with a two-item questionnaire (PHQ-2) publication-title: J Psychosom Res doi: 10.1016/j.jpsychores.2004.09.006 – volume: 96 start-page: 1076 issue: 8 year: 2005 ident: ref7 article-title: Screening for depression in patients with coronary heart disease (data from the Heart and Soul study) publication-title: Am J Cardiol doi: 10.1016/j.amjcard.2005.06.037 – volume: 184 start-page: e191 issue: 3 year: 2012 ident: ref5 article-title: Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis publication-title: CMAJ doi: 10.1503/cmaj.110829 – volume: 101 start-page: 952 issue: 3 Pt 1 year: 2007 ident: ref10 article-title: The patient health questionnaire, Japanese version: validity according to the mini-international neuropsychiatric interview-plus publication-title: Psychol Rep – reference: 22759625 - BMC Psychiatry. 2012;12:73 – reference: 20644190 - Ann Fam Med. 2010 Jul-Aug;8(4):348-53 – reference: 15820844 - J Psychosom Res. 2005 Feb;58(2):163-71 – reference: 16163400 - Prim Care Companion J Clin Psychiatry. 2005;7(4):167-76 – reference: 24029431 - Gen Hosp Psychiatry. 2013 Nov-Dec;35(6):592-7 – reference: 8864147 - Br J Psychiatry Suppl. 1996 Jun;(30):38-43 – reference: 12220799 - Gen Hosp Psychiatry. 2002 Sep-Oct;24(5):328-35 – reference: 18232454 - Psychol Rep. 2007 Dec;101(3 Pt 1):952-60 – reference: 22184363 - CMAJ. 2012 Feb 21;184(3):E191-6 – reference: 16214441 - Am J Cardiol. 2005 Oct 15;96(8):1076-81 – reference: 17874169 - J Gen Intern Med. 2007 Nov;22(11):1596-602 – reference: 16194252 - Psychiatry Clin Neurosci. 2005 Oct;59(5):517-26 |
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SubjectTerms | Age Factors Ambulatory Care Facilities Cardiovascular disease Case-Control Studies Depression (Mood disorder) Depressive Disorder, Major - diagnosis Disorders Health Health aspects Health care Health surveys Hospitals Humans Internal medicine Japan Mass Screening Medical diagnosis Medical personnel Medicine Mental depression Middle Aged Patients Physicians Physicians, Primary Care Primary care Psychiatry Quality of life Questionnaires ROC Curve Screening Sensitivity Surveys Surveys and Questionnaires Validity |
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Title | Screening for Major Depressive Disorder with the Patient Health Questionnaire (PHQ-9 and PHQ-2) in an Outpatient Clinic Staffed by Primary Care Physicians in Japan: A Case Control Study |
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