Bernard Charlotte, Font Hélène, Zotova Natalia, Wools-Kaloustian Kara, Goodrich Suzanne, Kwobah Edith Kamaru, Awoh Ajeh Rogers, Nko'o Mbongo'o Guy Calvin, Nsonde Dominique Mahambu, Gandou Paul, Minga Albert, Tine Judicaël Malick, Ndiaye Ibrahima, Dabis François, Seydi Moussa, de Rekeneire Nathalie, Yotebieng Marcel, Jaquet Antoine
University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France.
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
J Acquir Immune Defic Syndr. 2025 Feb 1;98(2):143-149. doi: 10.1097/QAI.0000000000003551.
Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The 9-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH.
Five HIV programs in Cameroon, Côte d'Ivoire, Kenya, Senegal, and the Republic of Congo.
Adult PLWH were screened for depression during the 2018-2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity and area under the curve (AUC) of the traditional PHQ-9 scoring (positive screening - score ≥ 10), were compared to alternative scoring algorithms including (1) the presence of ≥1 mood symptom (PHQ-9 items 1 and 2) combined with ≥2 other symptoms listed in the PHQ-9, and (2) a simplified recoding of each 4-response item into 2 categories (absence/presence).
A total of 735 participants were included [54% women, median age 42 years (interquartile range 34-50)]. Depression was diagnosed by a psychiatrist in 95 (13%) participants. Alternative scoring sensitivities (0.59-0.74) were higher than that of the traditional score's (0.39). Compared to traditional scoring, AUC was significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability.
As a primary screening test, new scoring algorithms seemed to improve the PHQ-9 sensitivity in identifying depression and reducing heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations.
对于接受治疗的HIV感染者（PLWH）而言，抑郁症筛查仍是一项重点工作。9项患者健康问卷（PHQ-9）是一种广泛使用的抑郁症筛查工具，但在不同文化背景下应用时准确性有限。我们旨在评估替代PHQ-9评分算法在撒哈拉以南非洲PLWH中的表现。
喀麦隆、科特迪瓦、肯尼亚、塞内加尔和刚果共和国的五个HIV项目。
在2018年至2022年期间对成年PLWH进行抑郁症筛查。通过精神科医生盲法临床评估（金标准）进行诊断确认。将传统PHQ-9评分（阳性筛查——得分≥10）的诊断性能，包括敏感性和曲线下面积（AUC），与替代评分算法进行比较，替代评分算法包括：（1）存在≥1种情绪症状（PHQ-9第1和2项）并伴有PHQ-9中列出的≥2种其他症状；（2）将每个4级反应项目简化重新编码为2类（不存在/存在）。
共纳入735名参与者[54%为女性，中位年龄42岁（四分位间距34 - 50岁）]。95名（13%）参与者被精神科医生诊断为抑郁症。替代评分敏感性（0.59 - 0.74）高于传统评分（0.39）。与传统评分相比，PHQ-9替代评分的AUC显著更高。在所有研究地点，替代评分算法提高了敏感性并降低了变异性。
作为一项初步筛查测试，新的评分算法似乎提高了PHQ-9在识别抑郁症方面的敏感性，并减少了不同研究地点之间的异质性。这种替代方法可能有助于识别需要转诊进行进一步诊断评估的PLWH。
