Article

Concordance between the PHQ-9 and the HSCL-20 in depressed primary care patients

Cornell University, Итак, New York, United States
Journal of Affective Disorders (Impact Factor: 3.71). 05/2007; 99(1-3):139-45. DOI: 10.1016/j.jad.2006.09.002
Source: PubMed

ABSTRACT Two instruments commonly used in primary care research to measure depressive severity are the Patient Health Questionnaire-9 (PHQ-9) and the Hopkins Symptom Checklist-20 (HSCL-20). However, there is little information regarding the relationship between clinical information derived from these scales. The present study investigates the psychometric properties of the PHQ-9 and HSCL-20, determines the degree of instrument concordance, and describes the factor structure of the HSCL-20.
A secondary data analysis from a randomized controlled trial was performed. A total of 405 primary care patients with major depressive disorder and/or dysthymia were administered the PHQ-9 and the HSCL-20 when recruited for the study.
Good internal consistency reliability estimates were obtained for both scales (PHQ-9 alpha=0.803; HSCL-20 alpha=0.837). All PHQ-9 inter-item and corrected item-total correlations showed that no item detracted from overall scale functioning. HSCL-20 items assessing overeating, poor appetite, and sexual interest were poorly correlated with other items and with the total scale score. A positive, moderate strength relationship was found between the instruments (r=0.54, p<0.0001). Exploratory factor analysis of the HSCL-20 yielded a six-factor structure, which accounted for almost 63% of the variance in total score. The largest contribution to common variance in the scale was provided by an "anxiety and self-reproach" factor.
PHQ-9 and HSCL-20 total scores were moderately correlated. Although the HSCL-20 is utilized as a measure of depression severity, it may lack sufficient specificity to be an accurate reflection of depression status per se.

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    • "Telephone administration of the Patient Health Questionnaire (PHQ9) has been validated in stroke patients (Lee et al. 2007). This instrument has demonstrated reliability as a screening tool for Post Stroke Depression (Williams et al. 2005). "
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    • "The PHQ-9 (Kroenke et al., 2001) is a widely used selfreport measure of depression that is brief, easy to administer and has well-established psychometric properties (Lee et al., 2007). For these reasons it has been recommended as an integral part of the management of depression in primary care, including tracking symptom change and defining successful treatment outcome to inform treatment decisions (Clark et al., 2009; Dejesus et al., 2007). "
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    • "It was omitted because interviewers are not able to provide adequate intervention by telephone. Research indicates that the deletion of this question has only a minor effect on scoring because thoughts of self-harm are fairly uncommon in the general population, and the ninth item is by far the least frequently endorsed item on the PHQ-9 (Huang et al., 2006a; Kroenke and Spitzer, 2002; Lee et al., 2007; Rief et al., 2004). Indeed, the two original validation studies of the PHQ totaling 6000 patients established that identical scoring thresholds for depression severity could be used for the PHQ-9 and PHQ-8 (Kroenke and Spitzer, 2002). "
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