Citation

Bombardier CH, Kalpakjian CV, Graves DE, Dyer J, Tate D, Fann JR. Arch. Phys. Med. Rehabil. 2012; 93(10): 1838-1845.

Affiliation

Department of Rehabilitation Medicine, University of Washington, Seattle WA.

Copyright

(Copyright © 2012, Elsevier Publishing)

DOI

10.1016/j.apmr.2012.04.019

PMID

22555007

Abstract

OBJECTIVE: To investigate the validity of the Patient Health Questionnaire-9 (PHQ-9) depression screening measure in people undergoing acute inpatient rehabilitation for spinal cord injury (SCI) DESIGN: We performed a blinded comparison of the PHQ-9 administered by research staff to the major depression module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV SCID) conducted by a mental health professional. SETTING: Inpatient rehabilitation units in Seattle WA, Ann Arbor MI and Houston TX. PARTICIPANTS: Patients undergoing acute rehabilitation for traumatic SCI who were at least 18 years old, English speakers without severe cognitive, motor speech or psychotic disorders. We obtained the SCID on 173/204 (84%) of eligible patients. The final sample 142 (69%) consisted of those who underwent both assessments within 7 days of each other. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PHQ-9 and SCID major depression module. RESULTS: Participants were on average 42.2 years old, 78.2% male, 81.7% Caucasian and 66.9% had cervical injuries. The optimal PHQ-9 cutoff (≥ 11) resulted in 35 (24.6%) positive screens. Key indices of criterion validity were: sensitivity = 1.00 (95% confidence interval [CI], 0.73-1.00), specificity = 0.84 (95% CI, 0.76-0.89), Youden Index = 0.84, positive predictive value = 0.40 (95% CI, 0.24-0.58) and negative predictive value = 1.00 (95% CI, 0.96-1.00). The area under the receiver operator curve was 0.92 and kappa was 0.50. Total PHQ-9 scores were inversely correlated with subjective health state and quality of life since SCI. CONCLUSION: The PHQ-9 meets criteria for good diagnostic accuracy compared to a structured diagnostic assessment for MDD even in the context of inpatient rehabilitation for acute traumatic SCI.

Language: en