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

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

Current major depressive syndrome measured with the Patient Health Questionnaire-9 (PHQ-9) and the Composite International Diagnostic Interview (CIDI): results from a cross-sectional population-based study of adults in Germany

Authors: Ulrike E Maske, Markus A Busch, Frank Jacobi, Katja Beesdo-Baum, Ingeburg Seiffert, Hans-Ulrich Wittchen, Steffi Riedel-Heller, Ulfert Hapke

Published in: BMC Psychiatry | Issue 1/2015

Login to get access

Abstract

Background

Prevalence estimates for depression vary considerably by the type of assessment instrument, and there is limited information on their overlap in population-based samples. Our aim was to compare the Patient Health Questionnaire-9 (PHQ-9) with the Composite International Diagnostic Interview (CIDI) as measures for current major depressive syndrome (MDS) in a large population-based sample.

Methods

Data derived from the mental health module of the nationwide cross-sectional German Health Interview and Examination Survey for Adults (DEGS1-MH) (n = 4483; age 18–79 years). MDS in the past two weeks was assessed (a) using the PHQ-9 diagnostic algorithm (PHQ-MDS) and (b) based on CIDI information about the latest symptom occurrence (recency) (CIDI-MDS). Prevalences, overall concordance and percentages of overlap of both MDS measures were determined. Prevalences of affirmed PHQ-9 depression symptoms and the mean and median PHQ-9 sum scores were analyzed per measure.

Results

Prevalence of current MDS was 2.7% (95% CI: 2.0-3.6) for PHQ-MDS and 3.9% (95% CI: 3.1-5.0) for CIDI-MDS. The overall agreement between both measures was moderate (kappa: 0.43). Of all the participants, 1.5% (95% CI: 1.0-2.2) were classified as MDS cases by both measures, with 54.5% (95% CI: 42.7-65.9) of PHQ-MDS cases and 37.9% (95% CI: 27.8-49.1) of CIDI-MDS cases also being classified as MDS by the respective other MDS measure. However, 94.8% (95% CI: 93.6-95.8) of the participants were classified as non-MDS by both measures, with 97.5% (95% CI: 96.6-98.1) of non-PHQ-MDS and 98.7% (95% CI: 98.2-99.1) of non-CIDI-MDS being classified as non-MDS by the respective other MDS measure. The mean and median PHQ-9 sum score was higher in those with PHQ-MDS than in those with CIDI-MDS.

Conclusions

Both measures have a high level of agreement for ruling out current MDS, but the overlap in their classification of cases is moderate. Our results indicate that they cannot be interpreted as equal measures of the same construct, suggesting limited comparability of their prevalence estimates. However, further exploration of algorithms and correlates and a proper labeling of measures in epidemiological studies are required.
Literature
1.
Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJ, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10, e1001547.CrossRefPubMedPubMedCentral
2.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.CrossRefPubMed
3.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition text revised. Washington, DC: American Psychiatric Association; 2000.
4.
Jacobi F, Hofler M, Siegert J, Mack S, Gerschler A, Scholl L, et al. Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH). Int J Methods Psychiatr Res. 2014;23:304–19.CrossRefPubMed
5.
Kessler RC, Ustun TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13:93–121.CrossRefPubMed
6.
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, De Girolamo G, Guyer ME, Jin R, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res. 2006;15:167–80.CrossRefPubMed
7.
Wittchen HU, Pfister H. DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12Monate), PC-Programm zur Durchführung des Interviews (Längs-und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt: Swets und Zeitlinger; 1997.
8.
Baumeister H, Morar V. The impact of clinical significance criteria on subthreshold depression prevalence rates. Acta Psychiatr Scand. 2008;118:443–50.CrossRefPubMed
9.
Jacobi F, Wittchen HU, Holting C, Hofler M, Pfister H, Muller N, et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med. 2004;34:597–611.CrossRefPubMed
10.
Rumpf HJ, Meyer C, Hapke U, John U. Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res. 2001;105:243–53.CrossRefPubMed
11.
Carta MG, Mura G, Lecca ME, Moro MF, Bhat KM, Angermeyer MC, et al. Decreases in depression over 20 years in a mining area of Sardinia: due to selective migration? J Affect Disord. 2012;141:255–60.CrossRefPubMed
12.
Reed V, Gander F, Pfister H, Steiger A, Sonntag H, Trenkwalder C, et al. To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. Int J Methods Psychiatr Res. 1998;7:142–55.CrossRef
13.
14.
Kroenke K, Spitzer RL, Williams JB, Lowe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345–59.CrossRefPubMed
15.
Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22:1596–602.CrossRefPubMedPubMedCentral
16.
Wittkampf KA, Naeije L, Schene AH, Huyser J, Van Weert HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry. 2007;29:388–95.CrossRefPubMed
17.
Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015;37:67–75.CrossRefPubMed
18.
Kamtsiuris P, Lange M, Hoffmann R, Schaffrath Rosario A, Dahm S, Kuhnert R, et al. The first wave of the German Health Interview and Examination Survey for Adults (DEGS1): sample design, response, weighting and representativeness. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:620–30.CrossRefPubMed
19.
Scheidt-Nave C, Kamtsiuris P, Goesswald A, Hoelling H, Lange M, Busch MA, et al. German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave. BMC Public Health. 2012;12:730.CrossRefPubMedPubMedCentral
20.
Jacobi F, Mack S, Gerschler A, Scholl L, Hofler M, Siegert J, et al. The design and methods of the mental health module in the German Health Interview and Examination Survey for Adults (DEGS1-MH). Int J Methods Psychiatr Res. 2013;22:83–99.CrossRefPubMed
21.
Löwe B, Spitzer RL, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ-D). Komplettversion und Kurzform. Testmappe mit Manual, Fragebögen, Schablonen. 2. Auflage. Karlsruhe: Pfizer; 2002.
22.
Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9:90.CrossRefPubMedPubMedCentral
23.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMed
24.
Brauns H, Scherer S, Steinmann S. The CASMIN educational classification in international comparative research. A European working book for demographic and socio-economic variables. In: Hoffmeyer-Zlotnik JHP, Wolf C, editors. Advances in Cross-National Comparison. New York: Kluwer; 2003. p. 221–44.CrossRef
25.
Wittchen H-U, Üstün TB, Kessler RC. Diagnosing mental disorders in the community. A difference that matters? Psychol Med. 1999;29:1021–7.CrossRefPubMed
26.
Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stoltzman RK, Farmer A, et al. A comparison of clinical and diagnostic interview schedule diagnoses. Physician reexamination of lay-interviewed cases in the general population. Arch Gen Psychiatry. 1985;42:657–66.CrossRefPubMed
27.
Brugha TS, Jenkins R, Taub N, Meltzer H, Bebbington PE. A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Psychol Med. 2001;31:1001–13.CrossRefPubMed
28.
World Health Organisation. The ICD-10 classification of mental health and behavioural disorders: clinical descriptions and diagnostic guidelines. 2nd ed. Geneva: World Health Organisation; 1993.
29.
Judd LL, Akiskal HS. Delineating the longitudinal structure of depressive illness: Beyond clinical subtypes and duration thresholds. Pharmacopsychiatry. 2000;33:3–7.CrossRefPubMed
30.
Kennedy N, Abbott R, Paykel ES. Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-Year follow-up study. Br J Psychiatry. 2004;184:330–6.CrossRefPubMed
31.
Karlsson L, Marttunen M, Karlsson H, Kaprio J, Hillevi A. Minor change in the diagnostic threshold leads into major alteration in the prevalence estimate of depression. J Affect Disord. 2010;122:96–101.CrossRefPubMed
Metadata
Title
Current major depressive syndrome measured with the Patient Health Questionnaire-9 (PHQ-9) and the Composite International Diagnostic Interview (CIDI): results from a cross-sectional population-based study of adults in Germany
Authors
Ulrike E Maske
Markus A Busch
Frank Jacobi
Katja Beesdo-Baum
Ingeburg Seiffert
Hans-Ulrich Wittchen
Steffi Riedel-Heller
Ulfert Hapke
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0463-4

Other articles of this Issue 1/2015

BMC Psychiatry 1/2015 Go to the issue

Study protocol

Effectiveness of a brief psychoeducational group intervention for relatives on the course of disease in patients after inpatient depression treatment compared with treatment as usual – study protocol of a multisite randomised controlled trial

Research article

Exploring the relation between childhood trauma, temperamental traits and mindfulness in borderline personality disorder

Research article

Baseline characteristics and hospitalizations in patients with schizophrenia receiving olanzapine long-acting injection: an interim analysis from a non-interventional, prospective observational safety study

Research article

Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial

Research article

Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial

Study protocol

Cost-effectiveness of active monitoring versus antidepressants for major depression in primary health care: a 12-month non-randomized controlled trial (INFAP study)