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      The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility

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          Abstract

          Background

          Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility.

          Methods

          In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7.

          Results

          The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ 2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms.

          Conclusion

          Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.

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          Most cited references35

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          Principles and practice in reporting structural equation analyses.

          Roderick P. McDonald, Moon-Ho Ringo Ho (2002)
          Principles for reporting analyses using structural equation modeling are reviewed, with the goal of supplying readers with complete and accurate information. It is recommended that every report give a detailed justification of the model used, along with plausible alternatives and an account of identifiability. Nonnormality and missing data problems should also be addressed. A complete set of parameters and their standard errors is desirable, and it will often be convenient to supply the correlation matrix and discrepancies, as well as goodness-of-fit indices, so that readers can exercise independent critical judgment. A survey of fairly representative studies compares recent practice with the principles of reporting recommended here.
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            Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five well-being scale

            Mette Kjoller, Per Bech, Lis Olsen … (2003)
            The health status questionnaire Short‐Form 36 (SF‐36) includes subscales measuring both physical health and mental health. Psychometrically, the mental health subscale contains a mixture of mental symptoms and psychological well‐being items, among other things, to prevent a ceiling effect when used in general population studies. Three of the mental health well‐being items are also included in the WHO‐Five well‐being scale. In a Danish general population study, the mental health subscale was compared psychometrically with the WHO‐Five in order to evaluate the ceiling effect. Tests for unidimensionality were used in the psychometric analyses, and the sensitivity of the scales in differentiating between changes in self‐reported health over the past year has been tested. The results of the study on 9,542 respondents showed that, although the WHO‐Five and the mental health subscale were found to be unidimensional, the WHO‐Five had a significantly lower ceiling effect than the mental health subscale. The analysis identified the three depression symptoms in the mental health subscale as responsible for the ceiling effect. The WHO‐Five was also found to be significantly superior to the mental health subscale in terms of its sensitivity in differentiating between those persons whose health had deteriorated over the past year and those whose health had not. In conclusion, the WHO‐Five, which measures psychological well‐being, reflects aspects other than just the absence of depressive symptoms. Copyright © 2003 Whurr Publishers Ltd.
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              Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa.

              Bizu Gelaye, Michelle Williams, Seblewengel Lemma … (2013)
              Depression is often underdiagnosed and undertreated in primary care settings, particularly in developing countries. This is, in part, due to challenges resulting from lack of skilled mental health workers, stigma associated with mental illness, and lack of cross-culturally validated screening instruments. We conducted this study to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) as a screen for diagnosing major depressive disorder among adults in Ethiopia, the second most populous country in sub-Saharan Africa. A total of 926 adults attending outpatient departments in a major referral hospital in Ethiopia participated in this study. We assessed criterion validity and performance characteristics against an independent, blinded, and psychiatrist administered semi-structured Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. Overall, the PHQ-9 items showed good internal (Cronbach's alpha=0.81) and test re-test reliability (intraclass correlation coefficient=0.92). A factor analysis confirmed a one-factor structure. Receiver Operating Characteristics (ROC) analysis showed that a PHQ-9 threshold score of 10 offered optimal discriminatory power with respect to diagnosis of major depressive disorder via the clinical interview (sensitivity=86% and specificity=67%). The PHQ-9 appears to be a reliable and valid instrument that may be used to diagnose major depressive disorders among Ethiopian adults.
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                Author and article information

                Contributors
                Saman Maroufizadeh: saman.maroufizadeh@gmail.com
                Reza Omani-Samani: samani@royaninstitute.org
                Amir Almasi-Hashiani: amiralmasi2007@gmail.com
                Payam Amini: +98-9197552131 , payam.amini87@gmail.com
                Mahdi Sepidarkish: mahdi.sepidarkish@gmail.com
                Journal
                Journal ID (nlm-ta): Reprod Health
                Journal ID (iso-abbrev): Reprod Health
                Title: Reproductive Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1742-4755
                Publication date (Electronic): 9 September 2019
                Publication date PMC-release: 9 September 2019
                Publication date Collection: 2019
                Volume: 16
                Electronic Location Identifier: 137
                Affiliations
                [1 ]ISNI 0000 0004 0571 1549, GRID grid.411874.f, School of Nursing and Midwifery, , Guilan University of Medical Sciences, ; Rasht, Iran
                [2 ]GRID grid.417689.5, Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, , Royan Institute for Reproductive Biomedicine, ACECR, ; Tehran, Iran
                [3 ]ISNI 0000 0001 1218 604X, GRID grid.468130.8, Department of Epidemiology, School of Health, , Arak University of Medical Sciences, ; Arak, Iran
                [4 ]ISNI 0000 0000 9296 6873, GRID grid.411230.5, Department of Biostatistics and Epidemiology, School of Public Health, , Ahvaz Jundishapur University of Medical Sciences, ; Ahvaz, Iran
                [5 ]ISNI 0000 0004 0421 4102, GRID grid.411495.c, Department of Biostatistics and Epidemiology, , Babol University of Medical Sciences, ; Babol, Iran
                Article
                Publisher ID: 802
                DOI: 10.1186/s12978-019-0802-x
                PMC ID: 6734346
                PubMed ID: 31500644
                SO-VID: d8fb14e5-d66c-4803-ac43-9c304aeb9144
                Copyright © © The Author(s). 2019
                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.

                History
                Date received : 22 August 2018
                Date accepted : 2 September 2019
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: phq-9,phq-2,depression,reliability,validity,persian,infertility
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: phq-9, phq-2, depression, reliability, validity, persian, infertility

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