Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States.
U.S. Department of Veterans Affairs Medical Center, Providence, RI, United States.
Int J Geriatr Psychiatry. 2019 May;34(5):700-708. doi: 10.1002/gps.5074. Epub 2019 Mar 4.
The objective of this study was to assess the measurement properties of the self-reported Patient Health Questionnaire-9 (PHQ-9) and its 10-item observer version (PHQ-10OV) among nursing home residents.
We conducted a retrospective study of Minimum Data Set 3.0 assessments for national cohorts of Medicare Fee-for-Service beneficiaries who were newly admitted or incident long-stay residents in 2014-2015 at US nursing homes (NHs) certified by the Center for Medicare and Medicaid Services. Statistical analyses included examining internal reliability with McDonald's omega, structural validity with confirmatory factor analysis, and hypothesis testing for expected gender differences and criterion validity with descriptive statistics. The Chronic Condition Warehouse depression diagnoses were used as an administrative reference standard.
Both the PHQ-9 and PHQ-10OV had good internal reliability with omega values above 0.85. The self-reported scale yielded good model fit for a one-factor solution, while the PHQ-10OV had slightly poorer fit and a lower standardized factor loading on the additional irritability item. Both scales appear sufficiently one-dimensional given that somatic items had higher factor loading on a general depression factor than on a somatic subfactor. We were unable to obtain expected gender differences on the PHQ-10OV scale. The PHQ-9 and PHQ-10OV were both highly specific but had poor sensitivity compared with an administrative reference standard.
The PHQ-9 appears to be a valid and promising measurement instrument for research about depression among NH residents, while the validity of the PHQ-10OV should be examined further with a structured psychiatric interview as a stronger criterion standard.
本研究旨在评估患者健康问卷-9（PHQ-9）及其 10 项观察版本（PHQ-10OV）在养老院居民中的测量特性。
我们对 2014-2015 年美国医疗保险和医疗补助服务中心认证的养老院新入住或长期居住的医疗保险费用服务受益人进行了最小数据集合 3.0 评估的回顾性研究。统计分析包括使用 McDonald's omega 检验内部信度、使用验证性因子分析检验结构效度、检验预期的性别差异假设和使用描述性统计检验标准效度。慢性疾病仓库的抑郁诊断被用作行政参考标准。
PHQ-9 和 PHQ-10OV 的内部信度均良好，omega 值均高于 0.85。自评量表对于单因素解决方案具有良好的模型拟合，而 PHQ-10OV 的拟合稍差，并且在额外的易怒项目上的标准化因子负荷较低。考虑到躯体项目在一般抑郁因子上的因子负荷高于躯体子因子，这两个量表似乎都具有足够的一维性。我们无法在 PHQ-10OV 量表上获得预期的性别差异。PHQ-9 和 PHQ-10OV 均具有高度特异性，但与行政参考标准相比，敏感性较差。
PHQ-9 似乎是评估养老院居民抑郁的有效且有前途的测量工具，而 PHQ-10OV 的有效性应进一步通过结构化精神病学访谈进行检验，作为更强的标准。
