Abstract:
epression greatly burdens sub-
Saharan Africa, especially populations living with HIV/
AIDS, for whom few validated depression scales exist.
Patient Health Questionnaire-9 (PHQ-9), a brief dual-
purpose instrument yielding DSM-IV diagnoses and
severity, and PHQ-2, an ultra-brief screening tool, offer
advantages in resource-constrained settings.
and depression severity among adults living with
HIV/AIDS in western Kenya.
KEY WORDS: HIV/AIDS; Kenya; Africa; depression; PHQ-9.
J Gen Intern Med 24(2):189–97
DOI: 10.1007/s11606-008-0846-z
© Society of General Internal Medicine 2008
OBJECTIVE: To assess the validity/reliability of PHQ-9
and PHQ-2.
DESIGN: Observational, two occasions 7 days apart.
PARTICIPANTS: A total of 347 patients attending
psychosocial support groups.
MEASUREMENTS: Demographics, PHQ-9, PHQ-2,
general health perception rating and CD4 count.
RESULTS: Rates for PHQ-9 DSM-IV major depressive
disorder (MDD), other depressive disorder (ODD) and any
depressive disorder were 13%, 21% and 34%. Depression
was associated with female gender, but not CD4. Con-
struct validity was supported by: (1) a strong association
between PHQ-9 and general health rating, (2) a single
major factor with loadings exceeding 0.50, (3) item-total
correlations exceeding 0.37 and (4) a pattern of item
means similar to US validation studies. Four focus groups
indicated culturally relevant content validity and minor
modifications to the PHQ-9 instructions. Coefficient alpha
was 0.78. Test-retest reliability was acceptable: (1) intra-
class correlation 0.59 for PHQ-9 total score, (2) kappas
0.24, 0.25 and 0.38 for PHQ-9 MDD, ODD and any
depressive disorder and (3) weighted kappa 0.53 for
PHQ-9 depression severity categories. PHQ-2 ≥3 demon-
strated high sensitivity (85%) and specificity (95%) for
diagnosing any PHQ-9 depressive disorder (AUC, 0.97),
and 91% and 77%, respectively, for diagnosing PHQ-9
MDD (AUC, 0.91). Psychometrics were also good within
four gender/age (18–35, 36–61) subgroups.
CONCLUSIONS: PHQ-9 and PHQ-2 appear valid/
reliable for assessing DSM-IV depressive disorder
