Williams Kimberly G, Sanderson Michael, Jette Nathalie, Patten Scott B
Department of Psychiatry (KGW, SBP) and Department of Community Health Sciences (MS, SBP), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (NJ), Icahn School of Medicine at Mount Sinai, New York.
Neurol Clin Pract. 2020 Jun;10(3):190-198. doi: 10.1212/CPJ.0000000000000748. Epub 2020 Apr 13.
Because of symptom overlap, there is uncertainty about the validity of depression rating scales in neurologic populations. The objectives of this study were to evaluate the validity of the Patient Health Questionnaire-9 (PHQ-9) for detecting Diagnostic and Statistical Manual-defined major depressive episodes in people with neurologic conditions.
Participants were recruited from outpatient clinics for multiple sclerosis, epilepsy, migraine, Parkinson disease, and stroke for this cross-sectional study. Participants were administered a questionnaire (this included the PHQ-9), chart review, and a follow-up telephone interview. The Structured Clinical Interview for Depression was used as the reference standard for psychiatric diagnoses. The performance of PHQ-9 was analyzed using sensitivity, specificity, diagnostic odds ratios (DORs), and receiver operator curve analysis.
All neurologic subpopulations had a specificity greater than 78% and sensitivity greater than 79% at a cut-point of 10. Using a random-effects model, the I-squared value was 13.7%, and Tau was 0.05, showing homogeneity across the neurologic subpopulations. The pooled DOR was 25.3 (95% confidence interval [CI] 14.9-42.8). Meta-analytic analysis found that for sensitivity, the pooled estimate was 90% (95% CI 81-97), and for specificity, it was 85% (95% CI 79-90).
Despite theoretical concerns about its validity, the PHQ-9 performed well at its standard cut-point of 10. Consistent with the literature, being able to use a validated, brief tool that is available publicly should improve case finding of depression in neurologic populations. When considering clinical practicality along with the findings of this analyzed, this study confirmed that the PHQ-9 is valid in a general outpatient neurologic population.
由于症状重叠，抑郁评定量表在神经系统疾病人群中的有效性存在不确定性。本研究的目的是评估患者健康问卷-9（PHQ-9）在检测患有神经系统疾病的人群中符合《精神疾病诊断与统计手册》定义的重度抑郁发作方面的有效性。
本横断面研究的参与者从多发性硬化症、癫痫、偏头痛、帕金森病和中风的门诊诊所招募。参与者接受了问卷调查（包括PHQ-9）、病历审查和随访电话访谈。抑郁结构化临床访谈被用作精神疾病诊断的参考标准。使用敏感性、特异性、诊断比值比（DOR）和受试者操作特征曲线分析来分析PHQ-9的性能。
在临界值为10时，所有神经系统亚组的特异性均大于78%，敏感性均大于79%。使用随机效应模型，I²值为13.7%，Tau为0.05，表明各神经系统亚组之间具有同质性。合并DOR为25.3（95%置信区间[CI]14.9 - 42.8）。荟萃分析发现，敏感性的合并估计值为90%（95%CI 81 - 97），特异性为85%（95%CI 79 - 90）。
尽管在理论上对其有效性存在担忧，但PHQ-9在其标准临界值10时表现良好。与文献一致，能够使用一种经过验证的、公开可用的简短工具应能改善神经系统疾病人群中抑郁症的病例发现。结合本分析结果考虑临床实用性时，本研究证实PHQ-9在普通门诊神经系统疾病人群中是有效的。
