Articlegold2008

Reliability and validity of the Thai version of the PHQ-9

Manote Lotrakul · Sutida Sumrithe · Ratana Saipanish

420 citations0/0 files storedBMC Psychiatry

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychometric Methodologies and Testing Health Education and Validation

Abstract

BACKGROUND: Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients. METHODS: The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed. RESULTS: Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 >/= 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92). CONCLUSION: The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.

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References

2001The PHQ-9 1998The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10 2000Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures 1998The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.1967Development of a Rating Scale for Primary Depressive Illness 1998The mini international neuropsychiatric interview 1988The Composite International Diagnostic Interview 2004Global burden of depressive disorders in the year 2000

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2010The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong 2015Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis 2020The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital 2016Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies

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