Smith Meghan L, Sanchez Sixto E, Rondon Marta, Gradus Jaimie L, Gelaye Bizu
Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA.
Instituto de Investigación, Facultad deMedicina, Universidad de San Martin de Porres, Lima, Peru.
Curr Psychol. 2022 Jun;41(6):3797-3805. doi: 10.1007/s12144-020-00882-2. Epub 2020 Jul 2.
Depression during pregnancy is linked to adverse perinatal and offspring outcomes. The Patient Health Questionnaire-9 (PHQ-9) has been validated for identifying depression in pregnant women in limited cultural contexts. Construct validity and reliability have been assessed in Lima, Peru, but criterion validity has not. This study aimed to comprehensively evaluate the PHQ-9 among pregnant Peruvian women in the Pregnancy Outcomes, Maternal and Infant Study (PrOMIS). Using Composite International Diagnostic Interview (CIDI) criteria for past-12-month major depressive disorder as the reference standard, sensitivity, specificity, and predictive value of the PHQ-9 for detecting depression were assessed at various cutpoints of the PHQ-9. Confirmatory factor analysis (CFA) was used to evaluate one- and two-factor structures for the PHQ-9. Cronbach's alpha was computed for the entire PHQ-9 scale and for subscales supported by CFA. A cutpoint of ≥8 maximized combined sensitivity (61%) and specificity (62%). At this cutpoint, positive predictive value was low (15%) and negative predictive values was high (93%). Reliability for the full scale was high (α=0.80). Both one- and two-factor solutions were appropriate for this population, but a two-factor solution containing an affective/mood factor (α=0.67) and a somatic factor (α=0.75) was optimal (CFI=0.93, RMSEA=0.075). Among pregnant women in Lima, screening with the PHQ-9 can identify those in need of mental health care, but may identify a large number of false positive cases.
孕期抑郁与不良围产期及后代结局相关。患者健康问卷-9（PHQ-9）已在有限文化背景下被验证可用于识别孕妇抑郁。在秘鲁利马已评估了其结构效度和信度，但尚未评估效标效度。本研究旨在全面评估秘鲁孕妇在妊娠结局、母婴研究（PrOMIS）中使用PHQ-9的情况。以过去12个月重度抑郁症的复合国际诊断访谈（CIDI）标准作为参考标准，在PHQ-9的不同切点评估PHQ-9检测抑郁的敏感性、特异性和预测价值。采用验证性因素分析（CFA）评估PHQ-9的单因素和双因素结构。计算整个PHQ-9量表及CFA支持的子量表的克朗巴哈系数。切点≥8时，联合敏感性（61%）和特异性（62%）达到最大化。在此切点，阳性预测值较低（15%），阴性预测值较高（93%）。全量表的信度较高（α=0.80）。单因素和双因素解决方案均适用于该人群，但包含情感/情绪因素（α=0.67）和躯体因素（α=0.75）的双因素解决方案是最优的（CFI=0.93，RMSEA=0.075）。在利马的孕妇中，使用PHQ-9进行筛查可识别出需要心理健康护理的人群，但可能会识别出大量假阳性病例。
