Okeafor I N, Okeafor C U
Department of Public Health, Federal Ministry of Health, Nigeria.
Department of Mental Health, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
Ann Ib Postgrad Med. 2023 Jun;21(1):11-16.
Depression is one of the most common and devastating consequences among stroke survivors. In spite of the availability of treatment for depression, the non- or under-detection precludes patients from benefiting from it.
This study sought to validate the Patient Health Questionnaire (PHQ- 9) as a tool for detecting depression among patients with stroke.
A cross-sectional design comprising of adult patients diagnosed with stroke, who were attending the Neurology out-patient clinic of the University of Port Harcourt Teaching Hospital was employed in the study. The Receiver Operator Characteristics (ROC) curve and validity tests were performed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-DSM IV) as the gold standard. The optimal PHQ-9 cut-off was determined using Youden Index. Kappa statistics was performed at p<0.05.
The study had a total of 197 stroke cases with PHQ-9 and SCID-DSM IV findings. The median age was 54 years (range: 35-76 years). ROC Curve for PHQ-9 revealed an Area under the Curve (AUC) value of 0.93(95% CI: 0.88- 0.98). The optimal cut off value of six was obtained based on Youden Index. Sensitivity, specificity, positive predictive and negative predictive values at the optimal cut-off were 88.7%, 93.1%, 82.5% and 95.7% respectively. The Kappa statistics yielded 0.80 (95% CI: 0.68-0.86).
PHQ-9 is a useful screening tool for identifying depression among patients with stroke. An optimal cut-off score of six for PHQ-9 should be adopted for patients with stroke in Nigeria to identify depression, and the provision of holistic care.
抑郁症是中风幸存者中最常见且极具破坏性的后果之一。尽管有针对抑郁症的治疗方法，但未被检测出或检测不足使患者无法从中受益。
本研究旨在验证患者健康问卷（PHQ - 9）作为检测中风患者抑郁症的工具。
本研究采用横断面设计，纳入在哈科特港大学教学医院神经科门诊就诊的成年中风患者。以《精神疾病诊断与统计手册》（SCID - DSM IV）结构化临床访谈作为金标准，进行受试者操作特征（ROC）曲线和效度测试。使用约登指数确定PHQ - 9的最佳截断值。在p<0.05水平进行kappa统计。
本研究共有197例中风病例有PHQ - 9和SCID - DSM IV的结果。中位年龄为54岁（范围：35 - 76岁）。PHQ - 9的ROC曲线显示曲线下面积（AUC）值为0.93（95%CI：0.88 - 0.98）。根据约登指数得出最佳截断值为6。最佳截断值时的敏感性、特异性、阳性预测值和阴性预测值分别为88.7%、93.1%、82.5%和95.7%。kappa统计结果为0.80（95%CI：0.68 - 0.86）。
PHQ - 9是识别中风患者抑郁症的有用筛查工具。在尼日利亚，中风患者应采用PHQ - 9最佳截断分数6来识别抑郁症，并提供整体护理。
