Departments of Psychology.
Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark.
Clin J Pain. 2023 Oct 1;39(10):501-515. doi: 10.1097/AJP.0000000000001142.
Depression is prevalent among patients with chronic pain and may impact pain management. An accurate assessment is, however, complicated by overlapping symptoms. This study investigated how patients with high-impact chronic pain interpreted and responded to the Patient Health Questionnaire 9 (PHQ-9) to identify problematic items and causes hereof.
Cognitive interviews using the Three-Step Test-Interview procedure were conducted during the completion of the PHQ-9 in 33 patients with high-impact chronic pain referred to interdisciplinary treatment. Responses were analyzed using 4 coding categories: (1) "congruent" (response consistent with intention); (2) "incongruent" (response not consistent intention); (3) "ambiguous" (response both congruent and incongruent or insufficient to evaluate congruency); and (4) "confused" (response with confused or misunderstood statements). Next, the content of responses to problematic items was analyzed to identify causes for noncongruency, and encountered response difficulties were identified across all items.
Three items (items 2, 6, and 9) performed as intended (>97% congruent responses), while 7 items (items 1, 3, 4, 5, 7, 8, and 10) were identified as problematic (<50% congruent responses). Problematic items had 1 or more issues: Responses were based on (1) pain-related issues or (2) other (non-pain) factors unrelated to depression, or item structure caused response difficulties due to wordings, reversion, or having 2 questions in 1.
Problematic items limit the construct validity of the PHQ-9, leaving an increased risk of inflated depression scores in high-impact chronic pain. Identified problems should guide future revisions to enhance validity and screening accuracy for the benefit of both research and clinical practice.
抑郁在慢性疼痛患者中较为普遍，且可能会影响疼痛管理。然而，由于症状重叠，准确评估较为复杂。本研究通过调查高影响慢性疼痛患者对 9 项患者健康问卷（PHQ-9）的解读和反应，以确定有问题的项目及其原因。
在 33 名接受跨学科治疗的高影响慢性疼痛患者完成 PHQ-9 的过程中，使用三步测试-访谈程序进行认知访谈。使用 4 种编码类别分析反应：（1）“一致”（反应与意图一致）；（2）“不一致”（反应与意图不一致）；（3）“模糊”（反应既一致又不一致或不足以评估一致性）；（4）“困惑”（反应有混淆或误解的陈述）。然后，分析对有问题项目的反应内容，以确定不一致的原因，并确定所有项目中遇到的反应困难。
三项条目（条目 2、6 和 9）表现符合预期（>97%的一致反应），而 7 项条目（条目 1、3、4、5、7、8 和 10）则被确定为有问题（<50%的一致反应）。有问题的条目存在 1 个或多个问题：反应基于（1）与疼痛相关的问题或（2）与抑郁无关的其他（非疼痛）因素，或者由于措辞、反转或 1 个条目包含 2 个问题，导致条目结构造成反应困难。
有问题的条目限制了 PHQ-9 的结构有效性，使高影响慢性疼痛患者的抑郁评分增加风险。已识别的问题应指导未来的修订，以提高有效性和筛查准确性，从而造福于研究和临床实践。
