Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2020

01-12-2020 | Mood Disorders | Research article

Validation of the PHQ-9 depression scale in Ethiopian cancer patients attending the oncology clinic at Tikur Anbessa specialized hospital

Authors: Mikyas Degefa, Benyam Dubale, Fikirte Bayouh, Biniyam Ayele, Yared Zewde

Published in: BMC Psychiatry | Issue 1/2020

Login to get access

Abstract

Background

Although depression is highly prevalent among cancer patients, it is often underdiagnosed and poorly managed particularly in developing nations. These shortcomings can have substantial adverse effects not only on the disease prognosis but also on patients’ quality of life. The Patient Health Questionnaire-9 is a widely used depression screening tool but it has not been validated among patients with chronic illnesses such as cancer in Ethiopia. We aim to validate the PHQ-9 among Ethiopian cancer patients in an outpatient setting.

Methods

A cross-sectional study was conducted among cancer patients attending the oncology clinic at Tikur Anbessa Specialized Hospital (TASH). We assessed criterion validity and performance of the PHQ-9 test against the gold standard Mini-International Neuropsychiatric Interview (MINI) diagnostic tool among patients with cancer. The MINI was administered by psychiatric nurses who were blind to the initial PHQ-9 screening tool.

Results

A total of 163 patients completed the 2 stages of a diagnostic interview in the study. The majority (64%) of the participants were women, the mean age was 46 (13.5) years. Using the gold standard MINI test the prevalence of Major Depressive Episode (MDE) was 15%. The internal consistency (Cronbach’s α) for PHQ-9 was 0.78 suggesting good (acceptable) internal consistency for the reliability of the test scores. When the total PHQ-9 score was used to identify cases of MDE, the Area under the Curve (AUC) was 0.93 (95% confidence interval [CI], 0.88–0.97) on Receiver Operating Characteristic (ROC) analysis. This shows evidence for the excellent discriminating power of the PHQ-9 between cases and non-cases of MDE. At cutoff point ≥4, the PHQ-9 had a sensitivity of 88% and specificity of 78.1% on the ROC curve to detect MDE.

Conclusion

PHQ-9 is a reliable and valid instrument to detect MDE among individuals with chronic conditions such as cancer patients in outpatient settings and it can be used in resource-limited settings for early diagnosis and proper therapy of such patients.
Literature
1.
2.
Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;32:57–71.CrossRef
3.
Fallowfield L, Ratcliffe D, Jenkins V, Saul J. Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer. 2001;84(8):1011–5.CrossRefPubMedPubMedCentral
4.
Hardman A, Maguire P, Crowther D. The recognition of psychiatric morbidity on a medical oncology ward. J Psychosom Res. 1989;33(2):235–9.CrossRefPubMed
5.
Thombs BD, Ziegelstein RC, Whooley MA. Optimizing detection of major depression among patients with coronary artery disease using the patient health questionnaire: data from the heart and soul study. J Gen Intern Med. 2008;23(12):2014–7.CrossRefPubMedPubMedCentral
6.
Breuer E, Myer L, Struthers H, Joska J. HV/AIDS and mental health research in sub-Saharan Africa: a systematic review. Afr J AIDS Res. 2011;10(2):101–22.CrossRefPubMed
7.
Newport DJ, Nemeroff CB. Assessment and treatment of depression in the cancer patient. J Psychosom Res. 1998;45(3):215–37.CrossRefPubMed
8.
Bukberg J, Penman D, Holland JC. Depression in hospitalized cancer patients. Psychosom Med. 1984;46(3):199–212.CrossRefPubMed
9.
10.
Patel V, Araya R, Chowdhary N, et al. Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychol Med. 2008;38(2):221–8.CrossRefPubMed
11.
Patel V, Sartorius N. From science to action: the lancet series on global mental health. Curr Opinion Psychiatry. 2008;21(2):109–13.CrossRef
12.
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.CrossRefPubMed
13.
Monahan PO, Shacham E, Reece M, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24(2):189–97.CrossRefPubMed
14.
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. Int J Psychiatry Med. 2006;36(3):367–81.CrossRefPubMed
15.
Woldetensay YK, Belachew T, Tesfaye M, et al. Validation of the patient health questionnaire (PHQ-9) as a screening tool for depression in pregnant women: Afaan Oromo version. PLoS One. 2018;13(2):e0191782.CrossRefPubMedPubMedCentral
16.
Hanlon C, Medhin G, Selamu M, et al. Validity of brief screening questionnaires to detect depression in primary care in Ethiopia. J Affect Disord. 2015;186:32–9.CrossRefPubMed
17.
Orlandi L, Pinho JF, Murad MGR, et al. Depression diagnosed by the mini international neuropsychiatric interview plus (MINI) in patients with chronic obstructive pulmonary disease: relationship with functional capacity and quality of life. BMC Psychiatry. 2016;9:65.
18.
Buderer NM. Statistical methodology: I. incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad Emerg Med. 1996;3(9):895–900.CrossRefPubMed
19.
20.
Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the patient health questionnaire (PHQ-9). J Affect Disord. 2004;81(1):61–6.CrossRefPubMed
21.
Gelaye B, Williams MA, Lemma S, et al. Validity of the patient health Questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210(2):653–61.CrossRefPubMed
22.
Sheehan DV, Lecrubier Y, Sheehan KH, et al. 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. J Clin Psychiatry. 1998;59(Suppl 20):22–57.PubMed
23.
24.
National Collaborating Centre for Mental Health (UK). Depression: The Treatment and Management of Depression in Adults (Updated Edition). Leicester: British Psychological Society; 2010.
25.
Krebber AM, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23(2):121–30.CrossRefPubMed
26.
Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74.CrossRefPubMed
27.
Hinz A, Mehnert A, Kocalevent RD, et al. Assessment of depression severity with the PHQ-9 in cancer patients and in the general population. BMC Psychiatry. 2016;16:22.CrossRefPubMed
28.
Thekkumpurath P, Walker J, Butcher I, et al. Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer. 2011;117(1):218–27.CrossRefPubMed
29.
Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012;184(3):E191–6.CrossRefPubMedPubMedCentral
30.
Bhana A, Rathod SD, Selohilwe O, et al. The validity of the patient health questionnaire for screening depression in chronic care patients in primary health care in South Africa. BMC Psychiatry. 2015;15:118.CrossRefPubMedPubMedCentral
31.
Okulate GT, Olayinka MO, Jones OB. Somatic symptoms in depression: evaluation of their diagnostic weight in an African setting. Br J Psychiatry. 2004;184:422–7.CrossRefPubMed
Metadata
Title
Validation of the PHQ-9 depression scale in Ethiopian cancer patients attending the oncology clinic at Tikur Anbessa specialized hospital
Authors
Mikyas Degefa
Benyam Dubale
Fikirte Bayouh
Biniyam Ayele
Yared Zewde
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-02850-3

Other articles of this Issue 1/2020

BMC Psychiatry 1/2020 Go to the issue

Research article

Trajectories of posttraumatic stress symptoms during and after Narrative Exposure Therapy (NET) in refugees

Research article

Factors associated with resilience among non-local medical workers sent to Wuhan, China during the COVID-19 outbreak

Research article

Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress

Research article

Prevalence and determinants of perinatal depression among labour migrant and refugee women on the Thai-Myanmar border: a cohort study

Research article

Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia

Correction

Correction to: Study protocol for a randomized control trial to investigate the effectiveness of an 8-week mindfulness-integrated cognitive behavior therapy (MiCBT) transdiagnostic group intervention for primary care patients