Division of Psychological Medicine, King's College London, Western Education Centre, 10 Cutcombe Road, SE5 9RJ, London, UK.
Psychosom Med. 2013 Oct;75(8):791-7. doi: 10.1097/PSY.0b013e3182a2b108. Epub 2013 Aug 6.
To test the validity of the Patient Health Questionnaire-9 (PHQ-9) in adults with newly diagnosed Type 2 diabetes mellitus (T2DM) and compare the distribution of PHQ-9 items in those with and without Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) depression.
A two-stage survey design was used in primary care centers (n = 96). In Stage 1, participants were administered the PHQ-9 and biopsychosocial measures. In Stage 2, PHQ-9 positives (score ≥ 10) and randomly selected PHQ-9 negatives (score <10) had a diagnostic interview, Schedule for Clinical Assessment in Neuropsychiatry 2.1. The sensitivity, specificity and receiver operating characteristics of the PHQ-9 were calculated. The means of PHQ-9 items were compared.
Stage 1: Prevalence of PHQ-9 positives (completing Stage 2) was 12.1% (n = 182). PHQ-9 positives were younger (mean [standard deviation] age = 52.8 [9.47] versus 56.2 [11.50] years, p < .001) and had higher body mass index (32.7 [7.08] versus 31.6 [6.25] kg/m(2), p = .028) than PHQ-9 negatives (n = 1278). Stage 2: Prevalence of DSM-IV depression was 5.6% (n = 84). The optimal cutoff was ≥ 12 (sensitivity = 86.9%, specificity = 80.3%). PHQ-9 true positives scored significantly higher than PHQ-9 false positives on all items, excluding sleep (mean [standard deviation] score = 2.4 [0.98] versus 2.2 [1.06]), fatigue (2.5 [0.80] versus 2.3 [0.86]), and appetite (1.6 [1.23] versus 1.5 [1.26]).
Over-identification of depression by PHQ-9 in T2DM may be driven by presence of symptoms in keeping with an organic origin.
检验在新诊断为 2 型糖尿病（T2DM）的成年人中使用患者健康问卷-9（PHQ-9）的有效性，并比较 PHQ-9 项目在符合与不符合《精神障碍诊断与统计手册》第四版（DSM-IV）抑郁标准的患者中的分布情况。
在基层医疗中心采用两阶段调查设计（n = 96）。在第 1 阶段，参与者接受 PHQ-9 和生物心理社会措施评估。在第 2 阶段，PHQ-9 阳性（得分≥10）和随机选择的 PHQ-9 阴性（得分<10）进行了临床评估计划 2.1 诊断访谈。计算 PHQ-9 的灵敏度、特异性和受试者工作特征。比较 PHQ-9 项目的平均值。
第 1 阶段：PHQ-9 阳性（完成第 2 阶段）的患病率为 12.1%（n = 182）。PHQ-9 阳性者年龄更小（平均[标准差]年龄=52.8[9.47]岁与 56.2[11.50]岁，p<.001），体重指数（BMI）更高（32.7[7.08]kg/m2与 31.6[6.25]kg/m2，p=.028）高于 PHQ-9 阴性者（n = 1278）。第 2 阶段：DSM-IV 抑郁的患病率为 5.6%（n = 84）。最佳截断值为≥12（灵敏度=86.9%，特异性=80.3%）。PHQ-9 真阳性在所有项目上的得分均显著高于 PHQ-9 假阳性，除了睡眠（平均[标准差]得分=2.4[0.98]与 2.2[1.06]）、疲劳（2.5[0.80]与 2.3[0.86]）和食欲（1.6[1.23]与 1.5[1.26]）。
PHQ-9 在 T2DM 中对抑郁的过度识别可能是由与器质性起源一致的症状所致。
