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https://hdl.handle.net/1959.11/16456
Title: | Validity of the patient health questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa | Contributor(s): | Cholera, R (author); Gaynes, BN (author); Pence, BW (author); Bassett, J (author); Qangule, N (author); MacPhail, Catherine (author)![]() |
Publication Date: | 2014 | Open Access: | Yes | DOI: | 10.1016/j.jad.2014.06.003![]() |
Handle Link: | https://hdl.handle.net/1959.11/16456 | Open Access Link: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264106![]() |
Abstract: | Background: Integration of depression screening into primary care may increase access to mental health services in sub-Saharan Africa, but this approach requires validated screening instruments. We sought to validate the Patient Health Questionnaire-9 (PHQ-9) as a depression screening tool at a high HIV-burden primary care clinic in Johannesburg, South Africa. Methods: We conducted a validation study of an interviewer-administered PHQ-9 among 397 patients. Sensitivity and specificity of the PHQ-9 were calculated with the Mini International Neuropsychiatric Interview (MINI) as the reference standard; receiver operating characteristic (ROC) curve analyses were performed. Results: The prevalence of depression was 11.8%. One-third of participants tested positive for HIV. HIV-infected patients were more likely to be depressed (15%) than uninfected patients (9%; p=0.08). Using the standard cutoff score of ≥10, the PHQ-9 had a sensitivity of 78.7% (95% CI: 64.3-89.3) and specificity of 83.4% (95% CI: 79.1-87.2). The area under the ROC curve was 0.88 (95% CI: 0.83-0.92). Test performance did not vary by HIV status or language. In sensitivity analyses, reference test bias associated with the MINI appeared unlikely. Limitations: We were unable to conduct qualitative work to adapt the PHQ-9 to this cultural context. Conclusion: This is the first validation study of the PHQ-9 in a primary care clinic in sub-Saharan Africa. It highlights the potential for using primary care as an access point for identifying depressive symptoms during routine HIV testing. The PHQ-9 showed reasonable accuracy in classifying cases of depression, was easily implemented by lay health workers, and is a useful screening tool in this setting. | Publication Type: | Journal Article | Source of Publication: | Journal of Affective Disorders, v.167, p. 160-166 | Publisher: | Elsevier BV | Place of Publication: | Netherlands | ISSN: | 1573-2517 0165-0327 |
Fields of Research (FoR) 2008: | 111712 Health Promotion 111714 Mental Health |
Fields of Research (FoR) 2020: | 420603 Health promotion 420313 Mental health services |
Socio-Economic Objective (SEO) 2008: | 920410 Mental Health 920412 Preventive Medicine |
Socio-Economic Objective (SEO) 2020: | 200409 Mental health 200412 Preventive medicine |
Peer Reviewed: | Yes | HERDC Category Description: | C1 Refereed Article in a Scholarly Journal |
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Appears in Collections: | Journal Article |
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