Reliability and validity of the ultra-brief screening scale for depression and anxiety in outpatients clinics of community healthcare centers

Abstract

Abstract:

ObjectiveTo preliminary evaluate the reliability and validity of the ultra-brief screening scale for depression and anxiety [patient health questionnaire 4 (PHQ-4)] in outpatients clinics of community healthcare centers.MethodsTotally 313 patients were randomly selected from two community healthcare centers in Shanghai. The patients were asked to complete the PHQ-4 following the prescribed instruction with assistance of a psychiatrist and two physicians, and then were evaluated according Hamilton depression scale(HAMD) and the Hamilton anxiety scale(HAMA) followed by a mini international neuropsychiatric interview(MINI). Out of subjects screened, 50 patients were randomly selected to retest the PHQ-4. The reliability coefficients, retest reliability and criterion validity sensitivity and specificity were calculated. The receiver operating characteristic(ROC) analysis was performed to determine the best cut-off value, and the sensitivity and specificity accordingly.ResultsThe Cronbach’α coefficient of PHQ-4 was 0.833, the Spearman-Brown coefficient of the split-half reliability was 0.835. For the test-retest reliability, the intraclass correlation coefficient (ICC) was 0.969. The correlation coefficients of generalized anxiety disorder 7(GAD-7) with HAMD and HAMA were 0.391 and 0.407 respectively, both statistically significant (P<0.01). ROC analysis showed that the area under curve(AUC) was 0.919, and the best cut-off value was 3, the sensitivity and specificity of PHQ-4 were 87.1% and 82.6% respectively.ConclusionsThe Chinese version of the PHQ-4 maintains high reliability and validity in outpatient clinics of community healthcare centers, and is suitable for the screening of depression and anxiety.

Key words:The ultra-brief screening scale for depression and anxiety,Patient health questionnaire 4,Reliability,Validity,Community healthcare center outpatients

CLC Number:

R749.7

QIAN Jie, JIANG Minmin, CHEN Chen, CHEN Yujiao, YU Dehua, LI Chunbo. Reliability and validity of the ultra-brief screening scale for depression and anxiety in outpatients clinics of community healthcare centers[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(02): 116-120.

Figures/Tables4

类别	性别		年龄（岁）		婚姻状况		文化程度
例数[n（%）]	117(37.4)	196(62.6)	60(19.2)	103(32.9)	146(46.6)	4(1.3)	275(87.9)	34(10.9)	4(1.3)	103(32.9)	98(31.3)	105(33.5)	7(2.2)
PHQ-4（分）	1.38±1.85	1.34±1.93	0.72±1.22	1.27±1.89	1.71±2.07	-	1.28±1.74	2.03±2.82	-	1.46±2.26	1.83±1.83	0.89±1.46	-

PHQ-4	MINI	总计
阳性	27	49	76
阴性	4	233	237
总计	31	282	313

PHQ-4	条目1	条目2	条目3	条目4	PHQ-2总分	GAD-2总分	PHQ-4总分
条目1	1.000
条目2	0.600	1.000
条目3	0.505	0.669	1.000
条目4	0.547	0.562	0.566	1.000
PHQ-2总分	0.907	0.880	0.650	0.619	1.000
GAD-2总分	0.586	0.704	0.929	0.831	0.717	1.000
PHQ-4总分	0.823	0.864	0.837	0.770	0.941	0.910	1.000

References24

[1]	Mergl R, Seidscheck I, Allgaier AK, et al. Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition[J]. Depress Anxiety, 2010, 24(3): 185-195. doi:10.1002/da.20192 URL
[2]	李清伟, 陆峥. 重视综合医院和社区卫生医疗机构对焦虑障碍与抑郁障碍的识别和防治[J]. 中华全科医师杂志, 2016, 15(5): 321-324.
[3]	Huang Y, Wang Y, Wang H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3): 211-224. doi:10.1016/S2215-0366(18)30511-X URL
[4]	Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society[J]. Depress Anxiety, 2010, 16(4): 162-171. doi:10.1002/da.10065 URL
[5]	吴秋霞, 陈淑宝, 罗小阳, 等. 综合医院非精神科医师对广泛性焦虑障碍的知晓情况调查[J]. 中国临床心理学杂志, 2016, 24(5): 894-899.
[6]	李旭, 白文佩, 廖秦平, 等. 妇科门诊就诊者的抑郁症或(和)焦虑症患病率及妇科医生识别状况调查[J]. 中国全科医学, 2009, 12(23): 2144-2147.
[7]	王威. 沈阳市综合医院内科门诊焦虑障碍患病率与医生识别率现状调查[D]. 沈阳: 中国医科大学, 2007.
[8]	Zhang H, Yu D, Wang Z, et al. What impedes general practitioners’ identification of mental disorders at outpatient departments[J]?. Ann Glob Health, 2019, 85(1): 134.
[9]	Spitzer RL, Kroenke K, Williams JB, et al. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study[J]. JAMA, 1999, 282(18): 1737-1744. doi:10.1001/jama.282.18.1737 URL
[10]	Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure[J]. J Gen Intern Med, 2001, 16(9): 606-613. doi:10.1046/j.1525-1497.2001.016009606.xpmid:11556941
[11]	卞崔冬, 何筱衍, 钱洁, 等. 患者健康问卷抑郁症状群量表在综合性医院中的应用研究[J]. 同济大学学报(医学版), 2009, 30(5): 136-140.
[12]	Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7[J]. Arch Intern Med, 2006, 166(10): 1092-1097. doi:10.1001/archinte.166.10.1092pmid:16717171
[13]	何筱衍, 李春波, 钱洁, 等. 广泛性焦虑量表在综合性医院的信度和效度研究[J]. 上海精神医学, 2010, 22(4): 200-203.
[14]	Löwe B, Wahl I, Rose M, et al. A 4-item measure of depression and anxiety: validation and standardization of the patient health questionnaire-4 (PHQ-4) in the general population[J]. J Affect Disord, 2010, 122(1-2): 86-95. doi:10.1016/j.jad.2009.06.019 URL
[15]	Khubchandani J, Brey R, Kotecki J, et al. The psychometric properties of PHQ-4 depression and anxiety screening scale among college students[J]. Arch Psychiatr Nurs, 2016, 30(4): 457-462. doi:10.1016/j.apnu.2016.01.014 URL
[16]	Rodríguez-Muñoz MF, Ruiz-Segovia N, Soto-Balbuena C, et al. The psychometric properties of the patient health questionnaire-4 for pregnant women[J]. Int J Environ Res Public Health, 2020, 17(20): 7583. doi:10.3390/ijerph17207583 URL
[17]	Materu J, Kuringe E, Nyato D, et al. The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: a cross-sectional study[J]. BMC psychiatry, 2020, 20(1): 321. doi:10.1186/s12888-020-02735-5 URL
[18]	Ghaheri A, Omani-Samani R, Sepidarkish M, et al. The four-item patient health questionnaire for anxiety and depression: a validation study in infertile patients[J]. Int J Fertil Steril, 2020, 14(3): 234-239. doi:10.22074/ijfs.2020.44412pmid:33098392
[19]	Cano-Vindel A, Muñoz-Navarro R, et al. A computerized version of the patient health questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care[J]. J Affect Disord, 2018, 234: 247-255. doi:10.1016/j.jad.2018.01.030 URL
[20]	Kroenke K, Spitzer RL, Williams JB, et al. An ultra-brief screening scale for anxiety and depression: the PHQ-4[J]. Psychosomatics, 2009, 50(6): 613-621. doi:10.1176/appi.psy.50.6.613pmid:19996233
[21]	Lecrubier Y, Sheehan DV, Weiller E, et al. The mini international neuropsychiatric interview (MINI)[J]. Eur Psychiatry, 1997, 12(5): 224-231. doi:10.1016/S0924-9338(97)83296-8 URL
[22]	Sheehan DV, Lecrubier Y, Sheehan KH, et al. The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability[J]. Eur Psychiatry, 1997, 12(5): 232-241. doi:10.1016/S0924-9338(97)83297-X URL
[23]	司天梅, 舒良, 党卫民, 等. 简明国际神经精神访谈中文版的临床信效度[J]. 中国心理卫生杂志, 2009, 23(7): 30-36.
[24]	郭起浩, 黄琳. 我国临床神经心理测验的机遇、挑战与展望[J]. 内科理论与实践, 2020, 15(3): 137-140.