College of Social Work, Florida State University, Tallahassee, Florida, USA.
School of Social Work, University of Texas at Arlington, Arlington, Texas, USA.
Int J Methods Psychiatr Res. 2021 Mar;30(1):e1851. doi: 10.1002/mpr.1851. Epub 2020 Aug 30.
Screening instruments can be powerful tools in assisting primary care providers with detecting depression in their patients and monitoring treatment response. Health disparities among racial and ethnic minorities result from inaccurate assessment in primary care.
The current study used baseline data from two federally funded research studies of treatment for depression among Hispanics in primary care. The Patient Health Questionnaire-9 (PHQ-9) was administered at baseline prior to the study interventions, and 499 participants provided responses.
Confirmatory factor analyses found excellent factor validity for the PHQ-9, yet reliability remained poor. Possible heterogeneity in depressive item scores was examined, and latent profile analysis identified four distinct profiles of PHQ-9 responses. Profiles included a lower depression, moderate/somatization, moderate/negative self-view, and severe depression profiles. Results indicate modest support for the PHQ-9 and its use among Hispanics for the purpose of depression screening.
Capturing four profiles of depression in a large primary care sample helps characterize the manifestation of depression in a Hispanic population. The single item related to fatigue had the greatest variation across groups indicating it might be useful as a screening item. Inadequate evaluation of symptoms could lead to significant under identification of the disorder among Hispanics.
筛查工具可以成为帮助初级保健提供者在患者中发现抑郁并监测治疗反应的有力工具。 少数族裔和种族之间的健康差异源于初级保健中评估不准确。
本研究使用了两项联邦资助的针对初级保健中西班牙裔人群抑郁治疗的研究的基线数据。 在研究干预之前的基线时使用了患者健康问卷-9（PHQ-9），共有 499 名参与者提供了答复。
验证性因子分析发现 PHQ-9 的因子有效性很好，但可靠性仍然较差。 对抑郁项目得分的可能异质性进行了检查，潜在剖面分析确定了 PHQ-9 反应的四个不同模式。 这些模式包括较低的抑郁、中度/躯体化、中度/消极自我观和严重抑郁模式。 结果表明，PHQ-9 及其在西班牙裔人群中用于抑郁筛查的用途得到了适度支持。
在大型初级保健样本中捕捉抑郁的四个模式有助于描述西班牙裔人群中抑郁的表现。 与疲劳相关的单一项目在组间变化最大，表明它可能作为一个有用的筛查项目。 对症状的评估不足可能导致西班牙裔人群中该疾病的严重漏诊。
