肯尼亚西部感染艾滋病毒/艾滋病的成年人中PHQ-9和PHQ-2抑郁量表的效度/信度
Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya.
作者信息
Monahan Patrick O, Shacham Enbal, Reece Michael, Kroenke Kurt, Ong'or Willis Owino, Omollo Otieno, Yebei Violet Naanyu, Ojwang Claris
机构信息
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-3002, USA.
出版信息
J Gen Intern Med. 2009 Feb;24(2):189-97. doi: 10.1007/s11606-008-0846-z. Epub 2008 Nov 20.
BACKGROUND
Depression 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.
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. Construct 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) intraclass 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 > or =3 demonstrated 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 disorders and depression severity among adults living with HIV/AIDS in western Kenya.
背景
抑郁症给撒哈拉以南非洲地区带来了沉重负担，尤其是感染艾滋病毒/艾滋病的人群，针对这部分人群的有效抑郁症量表很少。患者健康问卷-9（PHQ-9）是一种简短的两用工具，可得出《精神疾病诊断与统计手册》第四版（DSM-IV）的诊断结果和严重程度，而PHQ-2是一种超简短筛查工具，在资源有限的环境中具有优势。
目的
评估PHQ-9和PHQ-2的效度/信度。
设计
观察性研究，两次测量间隔7天。
参与者
共有347名参加心理社会支持小组的患者。
测量指标
人口统计学特征、PHQ-9、PHQ-2、总体健康感知评分和CD4细胞计数。
结果
PHQ-9诊断为DSM-IV重度抑郁症（MDD）、其他抑郁症（ODD）和任何抑郁症的比例分别为13%、21%和34%。抑郁症与女性性别相关，但与CD4细胞计数无关。结构效度得到以下方面支持：（1）PHQ-9与总体健康评分之间存在强关联；（2）单一主要因子的载荷超过0.50；（3）项目与总分的相关性超过0.37；（4）项目均值模式与美国验证研究相似。四个焦点小组表明PHQ-9的内容效度与文化相关，并对PHQ-9的指导语进行了细微修改。克朗巴哈系数为0.78。重测信度可以接受：（1）PHQ-9总分的组内相关系数为0.59；（2）PHQ-9的MDD、ODD和任何抑郁症的卡帕值分别为0.24、0.25和0.38；（3）PHQ-9抑郁症严重程度分类的加权卡帕值为0.53。PHQ-2≥3对于诊断任何PHQ-9抑郁症具有高敏感性（85%）和高特异性（95%）（曲线下面积[AUC]为0.97），对于诊断PHQ-9的MDD分别为91%和77%（AUC为0.91）。在四个性别/年龄（18 - 35岁、36 - 61岁）亚组中，心理测量学指标也良好。
结论
PHQ-9和PHQ-2对于评估肯尼亚西部感染艾滋病毒/艾滋病成年人的DSM-IV抑郁症及抑郁症严重程度似乎有效/可靠。
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