An arabic translation, reliability, and validation of Patient Health Questionnaire in a Saudi sample

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Abstract

Background

Psychological disorders including depression and anxiety are not rare in primary care clinics. The Patient Health Questionnaire (PHQ) is a clinical diagnostic tool that is widely utilized by primary health care physicians worldwide because it provides a practical in-clinic tool to screen for psychological disorders. This study evaluated the validity of the Arabic version of the PHQ in all six modules including depression, anxiety, somatic, panic, eating, and alcohol abuse disorders.

Methods

This is a quantitative observational cross-sectional study that was conducted by administrating the translated Arabic version of PHQ to a sample of King Saud University students in Riyadh, Saudi Arabia.

Results

The sample was 731 university students who participated in this study including 376 (51.6%) females and 354 (48.4%) males with a mean age of 21.30 years. Eight mental health experts carried out the face validation process of the PHQ Arabic version. The internal consistency reliability was measured using Cronbach’s alpha for the PHQ9, GAD7, PHQ15, and panic disorder modules. The results were 0.857, 0.763, 0.826, and 0.696, respectively. In comparison, the eating disorders and alcohol abuse modules demonstrated poor internal consistency due to small number of participants in these modules.

Conclusion

This study demonstrates that the Arabic version of the PHQ is a valid and reliable tool to screen for depression, anxiety, somatic, and panic disorders in a Saudi sample.

Related collections

Most cited references 18

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

Manote Lotrakul, Sutida Sumrithe, Ratana Saipanish (2008)

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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Diagnosing ICD-10 depressive episodes: superior criterion validity of the Patient Health Questionnaire.

Bernd Löwe, Kerstin Gräfe, Stephan Zipfel … (2004)

Diagnosing and monitoring depression in primary care remains an issue of significant public health concern. Clinicians and researchers need to know if any one screening instrument is superior to the others in diagnosing ICD-10 depressive episodes. This study aimed to examine the criterion validity for diagnosing ICD-10 depressive episodes of the Patient Health Questionnaire (PHQ) in comparison with 2 well-established instruments, the Hospital Anxiety and Depression Scale (HADS), and the WHO Well-Being Index 5 (WBI-5). Five hundred and one medical outpatients completed the questionnaires and had a clinical interview. The presence of a depressive episode was determined with the International Diagnostic Checklists (IDCL) for ICD-10 as the criterion standard. Coefficient kappa (kappa), sensitivities and specificities were calculated and a statistical comparison of the areas under the receiver operating characteristic curves was performed. Diagnostic agreement between the questionnaires and the IDCL was moderate (kappa=0.34-0.56), with the highest values for the PHQ. While all 3 questionnaires had reasonable sensitivity and specificity, the operating characteristics for the PHQ were significantly superior to both the HADS and the WBI-5 (p=0.02). Any of the 3 screening instruments can be recommended for clinical use. However, this is the first comparative study to demonstrate the diagnostic advantage of a particular depression-screening instrument using the ICD-10 diagnostic criteria. The superior criterion validity of the PHQ is likely attributable to its closer representation of the current concept of depressive disorders.

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Adult depression screening in Saudi primary care: prevalence, instrument and cost

Waleed Al-Qadhi, Saeed ur Rahman, Mazen Ferwana … (2014)

Background By the year 2020 depression would be the second major cause of disability adjusted life years lost, as reported by the World Health Organization. Depression is a mental illness which causes persistent low mood, a sense of despair, and has multiple risk factors. Its prevalence in primary care varies between 15.3-22%, with global prevalence up to 13% and between 17-46% in Saudi Arabia. Despite several studies that have shown benefit of early diagnosis and cost-savings of up to 80%, physicians in primary care setting continue to miss out on 30-50% of depressed patients in their practices. Methods A cross sectional study was conducted at three large primary care centers in Riyadh, Saudi Arabia aiming at estimating point prevalence of depression and screening cost among primary care adult patients, and comparing Patient Health Questionnaires PHQ-2 with PHQ-9. Adult individuals were screened using Arabic version of PHQ-2 and PHQ-9. PHQ-2 scores were correlated with PHQ-9 scores using linear regression. A limited cost-analysis and cost saving estimates of depression screening was done using the Human Capital approach. Results Patients included in the survey analysis were 477, of whom 66.2% were females, 77.4% were married, and nearly 20% were illiterate. Patients exhibiting depressive symptoms on the basis of PHQ9 were 49.9%, of which 31% were mild, 13.4% moderate, 4.4% moderate-severe and 1.0% severe cases. Depression scores were significantly associated with female gender (p-value 0.049), and higher educational level (p-value 0.002). Regression analysis showed that PHQ-2 & PHQ-9 were strongly correlated R = 0.79, and R2 = 0.62. The cost-analysis showed savings of up to 500 SAR ($133) per adult patient screened once a year. Conclusion The point prevalence of screened depression is high in primary care visitors in Saudi Arabia. Gender and higher level of education were found to be significantly associated with screened depression. Majority of cases were mild to moderate, PHQ-2 was equivocal to PHQ 9 in utility and that screening for depression in primary care setting is cost saving.

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Author and article information

Contributors

Ahmad N. AlHadi: +966114692524 , alhadi@ksu.edu.sa

Deemah A. AlAteeq: dalateeq@gmail.com

Eman Al-Sharif: Eman.m.alsharif@gmail.com

Hamdah M. Bawazeer: Hmb333@hotmail.com

Hasan Alanazi: alanazihasan@gmail.com

Abdulaziz T. AlShomrani: azsham@hotmail.com

Raafat M. Shuqdar: shegdar@yahoo.com

Reem AlOwaybil: reem.obl@gmail.com

Journal

Journal ID (nlm-ta): Ann Gen Psychiatry

Journal ID (iso-abbrev): Ann Gen Psychiatry

Title: Annals of General Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1744-859X

Publication date (Electronic): 6 September 2017

Publication date PMC-release: 6 September 2017

Publication date Collection: 2017

Volume: 16

Electronic Location Identifier: 32

Affiliations

[1 ]ISNI 0000 0004 1773 5396, GRID grid.56302.32, Department of Psychiatry, College of Medicine, , King Saud University, ; Riyadh, Saudi Arabia

[2 ]ISNI 0000 0004 1773 5396, GRID grid.56302.32, College of Medicine, , King Saud University, ; Riyadh, Saudi Arabia

[3 ]College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

[4 ]ISNI 0000 0004 1754 9358, GRID grid.412892.4, College of Medicine, , Taibah University, ; Madinah, Saudi Arabia

[5 ]ISNI 0000 0004 1773 5396, GRID grid.56302.32, SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, , King Saud University, ; PO Box 242069, Riyadh, 11322 Saudi Arabia

Article

Publisher ID: 155

DOI: 10.1186/s12991-017-0155-1

PMC ID: 5585978

PubMed ID: 28878812

SO-VID: 80d09c37-dc91-4e71-bd1e-0d9a1424aa26

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.