Perlis Roy H, Gunning Faith M, Santillana Mauricio, Baum Matthew A, Druckman James N, Ognyanova Katherine, Lazer David
Center for Quantitative Health, Massachusetts General Hospital, Boston.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2025 Jul 1;8(7):e2522036. doi: 10.1001/jamanetworkopen.2025.22036.
Screening measures of depressive symptoms (eg, 9-item Patient Health Questionnaire [PHQ-9]) are increasingly used in surveys and remote applications, where shorter versions would be valuable.
To derive shorter versions of the PHQ-9 that maximize the variability in total depressive symptom severity captured.
DESIGN, SETTING, AND PARTICIPANTS: This survey study used data from 4 waves of a 50-state nonprobability web-based survey conducted between November 2, 2023, and July 21, 2024. Survey respondents were aged 18 years or older. The first survey wave data were used to identify shortened question subsets capturing variance in the PHQ-9 and estimating a PHQ-9 score of 10 or higher. Resulting models (eg, 3-item version of the PHQ [PHQ-3]) were validated in subsequent survey waves.
Performance of PHQ-3 in the full sample and across subgroups of age, gender, race and ethnicity, and educational levels. Depressive symptom severity was measured with the PHQ-9 (total score range: 0-27, with a score ≥10 indicating moderate or greater depressive symptoms).
In the 4 survey waves, there were 96 234 total participants (mean [SD] age, 47.3 [17.1] years; 55 245 [57.4%] identifying as women). In the full sample, 4401 participants (4.6%) identified as Asian American, 12 699 (13.2%) as Black or African American, 9776 (10.2%) as Hispanic or Latino, and 65 309 (67.9%) as White individuals, with 4049 (4.2%) who identified as having other race or ethnicity. Among these participants, the mean (SD) PHQ-9 score was 6.5 (6.6), and 25 411 (26.4%) met the criteria for moderate or greater depressive symptoms (PHQ-9 score ≥10). The optimal 3-item version, PHQ-3, used items 2 (subject: depressed mood), 6 (self-esteem or failure), and 1 (interest), yielding a Cronbach α of 0.88 (95% CI, 0.88-0.88) and Pearson correlation with the PHQ-9 total score of 0.93 (95% CI, 0.93-0.94). At a threshold of 3 or greater, the PHQ-3 sensitivity was 0.98 (95% CI, 0.97-0.98) and specificity was 0.76 (95% CI, 0.75-0.76) for moderate or greater depressive symptoms. Performance was consistent across sociodemographic subgroups and survey waves.
This survey study of US adults identified a 3-item scale that remained highly correlated with the full PHQ-9 instrument. The reduced set of questions could enable more widespread and efficient incorporation of depressive symptom measurement in general population samples.
抑郁症状筛查措施（如9项患者健康问卷[PHQ - 9]）在调查和远程应用中越来越常用，在此类场景中，更简短的版本会很有价值。
推导PHQ - 9的更简短版本，以最大程度地体现所捕捉到的总抑郁症状严重程度的变异性。
设计、设置和参与者：这项调查研究使用了2023年11月2日至2024年7月21日期间在50个州开展的基于网络的非概率性调查4个阶段的数据。调查对象为18岁及以上的成年人。第一阶段调查数据用于确定能捕捉PHQ - 9变异性并估计PHQ - 9得分达到10分及以上的简短问题子集。所得模型（如PHQ的3项版本[PHQ - 3]）在后续调查阶段进行验证。
PHQ - 3在全样本以及年龄、性别、种族和民族、教育水平等亚组中的表现。抑郁症状严重程度用PHQ - 9进行测量（总分范围：0 - 27分，得分≥10分表明存在中度或更严重的抑郁症状）。
在4个调查阶段，共有96234名参与者（平均[标准差]年龄为47.3[17.1]岁；55245名[57.4%]为女性）。在全样本中，4401名参与者（4.6%）为亚裔美国人，12699名（13.2%）为黑人或非裔美国人，9776名（10.2%）为西班牙裔或拉丁裔，65309名（67.9%）为白人，4049名（4.2%）为其他种族或民族。在这些参与者中，PHQ - 9平均（标准差）得分为6.5（6.6），25411名（26.4%）符合中度或更严重抑郁症状的标准（PHQ - 9得分≥10）。最佳的3项版本PHQ - 3使用了第2项（主题：情绪低落）、第6项（自尊或失败感）和第1项（兴趣），其克朗巴哈α系数为0.88（95%置信区间，0.88 - 0.88），与PHQ - 9总分的皮尔逊相关系数为0.93（95%置信区间，0.93 - 0.94）。对于中度或更严重的抑郁症状，在阈值为3分及以上时，PHQ - 3的灵敏度为0.98（95%置信区间，0.97 - 0.98），特异度为0.76（95%置信区间，0.75 - 0.76）。在社会人口统计学亚组和各调查阶段中，表现一致。
这项针对美国成年人的调查研究确定了一个3项量表，该量表与完整的PHQ - 9工具仍高度相关。问题数量的减少能够使抑郁症状测量在一般人群样本中得到更广泛且高效的应用。
