Reliability and validity of the Thai version of the PHQ-9

Manote Lotrakul, Sutida Sumrithe, Ratana Saipanish, Manote Lotrakul, Sutida Sumrithe, Ratana Saipanish

Abstract

Background: Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.

Methods: The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed.

Results: Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 >/= 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92).

Conclusion: The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.

Figures

Figure 1
Figure 1
The Receiver Operating Characteristic (ROC) curve of the PHQ-9 versus the MINI for major depression diagnosis.

References

    1. Ustun TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ. Global burden of depressive disorders in the year 2000. Br J Psychiatry. 2004;184:386–392. doi: 10.1192/bjp.184.5.386.
    1. Patel V, Araya R, Bolton P. Treating depression in the developing world. Trop Med Int Health. 2004;9:539–541. doi: 10.1111/j.1365-3156.2004.01243.x.
    1. Adewuya AO, Oguntade AA. Doctors' attitude towards people with mental illness in Western Nigeria. Soc Psychiatry Psychiatr Epidemiol. 2007;42:931–936. doi: 10.1007/s00127-007-0246-4.
    1. Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. Stigma in response to mental disorders: a comparison of Australia and Japan. BMC Psychiatry. 2006;6:21. doi: 10.1186/1471-244X-6-21.
    1. Hickie AMI, Davenport TA, Luscombe GM, Rong Y, Hickie ML, Bell MI. The assessment of depression awareness and help-seeking behaviour: experiences with the International Depression Literacy Survey. BMC Psychiatry. 2007;7:48. doi: 10.1186/1471-244X-7-48.
    1. Weiss MG, Raguram R, Channabasavanna SM. Cultural dimensions of psychiatric diagnosis. A comparison of DSM-III-R and illness explanatory models in south India. Br J Psychiatry. 1995;166:353–359.
    1. Lotrakul M, Saipanish R. Psychiatric services in primary care settings: a survey of general practitioners in Thailand. BMC family practice. 2006;7:48. doi: 10.1186/1471-2296-7-48.
    1. Kasantikul D, Karnjanathanalers N, Limsuwan N, Thongtang O, Vuthiganond S, Khuangsirikul V, Tantipiwatanakul P, Theeramoke V. Health-related self-report (HRSR) scale: the diagnostic screening test for depression in Thai population. Journal of the Medical Association of Thailand. 1997;80:647–657.
    1. Lotrakul M, Sukanich P. Development of the Thai Depression Inventory. Journal of the Medical Association of Thailand. 1999;82:1200–1207.
    1. Kuptniratsaikul V, Chulakadabba S, Ratanavijitrasil S. An instrument for assessment of depression among spinal cord injury patients: comparison between the CES-D and TDI. Journal of the Medical Association of Thailand. 2002;85:978–983.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21:547–552. doi: 10.1111/j.1525-1497.2006.00409.x.
    1. Lee PW, Schulberg HC, Raue PJ, Kroenke K. Concordance between the PHQ-9 and the HSCL-20 in depressed primary care patients. Journal of Affective Disorders. 2007;99:139–145. doi: 10.1016/j.jad.2006.09.002.
    1. Lowe B, Schenkel I, Carney-Doebbeling C, Gobel C. Responsiveness of the PHQ-9 to Psychopharmacological Depression Treatment. Psychosomatics. 2006;47:62–67. doi: 10.1176/appi.psy.47.1.62.
    1. Omoro SA, Fann JR, Weymuller EA, Macharia IM, Yueh B. Swahili translation and validation of the Patient Health Questionnaire-9 depression scale in the Kenyan head and neck cancer patient population. International Journal of Psychiatry in Medicine. 2006;36:367–381. doi: 10.2190/8W7Y-0TPM-JVGV-QW6M.
    1. Kittirattanapaiboon P, Khamwongpin M. The Validity of the Mini International Neuropsychiatric Interview (M.I.N.I.)-Thai Version 126. Journal of Mental Health of Thailand. 2005;13:126–136.
    1. Lotrakul M, Sukanit P, Sukying C. The validity and reliability of the Hamilton Rating scale for depression, Thai version. Journal of the Psychiatric Association of Thailand. 1996;41:235–246.
    1. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25:3186–3191. doi: 10.1097/00007632-200012150-00014.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry. 1998;59 Suppl 20:22–33;quiz 34-57.
    1. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278–296.
    1. Streiner DL, Cairney J. What's under the ROC? An introduction to receiver operating characteristics curves. Can J Psychiatry. 2007;52:121–128.
    1. Bech P. Acute therapy of depression. The Journal of Clinical Psychiatry. 1993;54 Suppl:18–27; discussion 28.
    1. Nease DE, Jr., Maloin JM. Depression screening: a practical strategy. The Journal of Family Practice. 2003;52:118–124.
    1. Streiner DL. Norman GR . Scaling responses. In: Health Measuremant Scales: a practical guide to their development and use . 2nd ed. Oxford , Oxford University Press; 1995. pp. 20–53.
    1. Lotrakul M. Saipanit R. Theeramoke W Symptoms of depression in Thai patients. ASEAN Journal of Psychiatry ; 1996; 4:24–32.
    1. Kirmayer LJ. Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. The Journal of Clinical Psychiatry. 2001;62 Suppl 13:22–8; discussion 29-30.
    1. Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA, et al. The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry. 1988;45:1069–1077.
    1. Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. General Hospital Psychiatry. 2007;29:417–424. doi: 10.1016/j.genhosppsych.2007.06.005.
    1. Koksalan OK. Low positive predictive values and specificities of spoligotyping and mycobacterial interspersed repetitive unit-variable-number tandem repeat typing methods for performing population-based molecular epidemiology studies of tuberculosis. Journal of Clinical Microbiology. 2005;43:3031; author reply 3031–2. doi: 10.1128/JCM.43.6.3031-3032.2005.
    1. Chen TM, Huang FY, Chang C, Chung H. Using the PHQ-9 for depression screening and treatment monitoring for Chinese Americans in primary care. Psychiatr Serv. 2006;57:976–981. doi: 10.1176/appi.ps.57.7.976.
    1. Lowe B, Kroenke K, Herzog W, Grafe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9) Journal of Affective Disorders. 2004;81:61–66. doi: 10.1016/S0165-0327(03)00198-8.
    1. Adewuya AO, Ola BA, Afolabi OO. Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. Journal of Affective Disorders. 2006;96:89–93. doi: 10.1016/j.jad.2006.05.021.
    1. Gilbody S, House AO, Sheldon TA. Screening and case finding instruments for depression. Cochrane database of systematic reviews (Online) 2005:CD002792.
    1. Cohen A, Kleinman A, Saraceno B. World mental health casebook: social and mental health programs in low-income countries. New York, Kluwer Academic/Plenum Publishers; 2002. p. x, 246.
    1. McKenzie K, Patel V, Araya R. Learning from low income countries: mental health. BMJ (Clinical research ed. 2004;329:1138–1140. doi: 10.1136/bmj.329.7475.1138.

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