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Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics

DOI: 10.1186/1472-6963-10-235

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Abstract:

197 diabetes patients from outpatient clinics in the Netherlands filled in the PHQ-9. Within 2 weeks they were approached for an interview with the Mini Neuropsychiatric Interview. DSM-IV diagnoses of Major Depressive Disorder (MDD) were the criterion for which the sensitivity, specificity, positive- and negative predictive values and Receiver Operator Curves (ROC) for the PHQ-9 were calculated.The cut-off point of a summed score of 12 on the PHQ-9 resulted in a sensitivity of 75.7% and a specificity of 80.0%. Predictive values for negative and positive test results were respectively 93.4% and 46.7%. The ROC showed an area under the curve of 0.77.The PHQ-9 proved to be an efficient and well-received screening instrument for MDD in this sample of diabetes patients in a specialized outpatient clinic. The higher cut-off point of 12 that was needed and somewhat lower sensitivity than had been reported elsewhere may be due to the fact that the patients from a specialized diabetes clinic have more severe pathology and more complications, which could be recognized by the PHQ-9 as depression symptoms, while instead being diabetes symptoms.Seven percent of adults in the USA have been diagnosed with Major Depressive Disorder (MDD) and in adults with chronic diseases, such as diabetes, this increases to over eleven percent [1]. Although the causal connection between the two remains unclear, the consequences are far-reaching. Having both diabetes and depression is associated with poor glycaemic control, resulting in more severe complications and a lower quality of life [2,3]. With the increasing severity of diabetes, the prevalence of depression also increases, and especially in vulnerable patients such as those with diabetes-related complications. Depression has severe consequences; underlining the importance of focus on the prevention of depression.Depression often remains unrecognized, and although several screening questionnaires are available, unfortunately, most questionn

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