Smith Fawzi Mary C, Ngakongwa Fileuka, Liu Yuanyuan, Rutayuga Theonest, Siril Hellen, Somba Magreat, Kaaya Sylvia F
Harvard Medical School, Department of Global Health and Social Medicine, Boston MA, USA.
Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, Dar es Salaam, Tanzania.
Neurol Psychiatry Brain Res. 2019 Feb;31:9-14. doi: 10.1016/j.npbr.2018.11.002. Epub 2018 Nov 18.
Major depression has a significant impact on years lived with disability (YLD) globally. In resource-limited countries, depression may accompany daily challenges of economic security that people face, hence there is a critical need to develop depression screening tools at primary levels of health care. The overall goal of the study is to validate the PHQ-9 in Tanzania.
A validation study was conducted from August to October 2014 among adults accessing primary health care at public clinics in Dar es Salaam. The Mini-International Neuropsychiatric Interview (MINI) was used as the gold standard for current major depressive episode.
Among 180 patients recruited, six were not included in the analysis since the PHQ-9 and MINI assessments were conducted more than two weeks apart (n=174). The PHQ-9 demonstrated reasonable reliability in this setting (α=0.83). Evidence for construct validity was observed through expected associations with female gender (r=0.16, p=0.04) and food insecurity (r=0.30, p<0.0001). Receiver Operating Characteristic analysis demonstrated good overall accuracy of the PHQ-9 (AOC=0.87, 95%CI: 0.77, 0.96). The optimal cut-off score in this population was 9, with a sensitivity of 78% and specificity of 87%.
The study sample is from a primary health care setting, hence the findings may have some limited generalizability at the community level.
The PHQ-9 demonstrated reliability and validity among adults accessing primary health care in Dar es Salaam, indicating that it can serve as a useful tool in identifying patients with depression in primary care clinics in Tanzania and similar settings.
重度抑郁症对全球残疾生存年数（YLD）有重大影响。在资源有限的国家，抑郁症可能伴随着人们面临的经济安全日常挑战，因此迫切需要在初级卫生保健层面开发抑郁症筛查工具。本研究的总体目标是在坦桑尼亚验证患者健康问卷-9（PHQ-9）。
2014年8月至10月，在达累斯萨拉姆公立诊所接受初级卫生保健的成年人中进行了一项验证研究。采用《迷你国际神经精神访谈量表》（MINI）作为当前重度抑郁发作的金标准。
在招募的180名患者中，有6名未纳入分析，因为PHQ-9和MINI评估间隔超过两周（n = 174）。PHQ-9在该环境中显示出合理的可靠性（α = 0.83）。通过与女性性别（r = 0.16，p = 0.04）和粮食不安全（r = 0.30，p < 0.0001）的预期关联观察到结构效度的证据。受试者工作特征分析表明PHQ-9具有良好的总体准确性（曲线下面积[AUC]=0.87，95%置信区间：0.77，0.96）。该人群的最佳截断分数为9，敏感性为78%，特异性为87%。
研究样本来自初级卫生保健机构，因此研究结果在社区层面的可推广性可能有限。
PHQ-9在达累斯萨拉姆接受初级卫生保健的成年人中显示出可靠性和有效性，表明它可作为在坦桑尼亚及类似环境的初级保健诊所中识别抑郁症患者的有用工具。
