The PHQ-8 as a Measure of Current Depression in the General Population

Department of Medicine, Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 09/2008; 114(1-3):163-73. DOI: 10.1016/j.jad.2008.06.026
Source: PubMed


The eight-item Patient Health Questionnaire depression scale (PHQ-8) is established as a valid diagnostic and severity measure for depressive disorders in large clinical studies. Our objectives were to assess the PHQ-8 as a depression measure in a large, epidemiological population-based study, and to determine the comparability of depression as defined by the PHQ-8 diagnostic algorithm vs. a PHQ-8 cutpoint > or = 10.
Random-digit-dialed telephone survey of 198,678 participants in the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS), a population-based survey in the United States. Current depression as defined by either the DSM-IV based diagnostic algorithm (i.e., major depressive or other depressive disorder) of the PHQ-8 or a PHQ-8 score > or = 10; respondent sociodemographic characteristics; number of days of impairment in the past 30 days in multiple domains of health-related quality of life (HRQoL).
The prevalence of current depression was similar whether defined by the diagnostic algorithm or a PHQ-8 score > or = 10 (9.1% vs. 8.6%). Depressed patients had substantially more days of impairment across multiple domains of HRQoL, and the impairment was nearly identical in depressed groups defined by either method. Of the 17,040 respondents with a PHQ-8 score > or = 10, major depressive disorder was present in 49.7%, other depressive disorder in 23.9%, depressed mood or anhedonia in another 22.8%, and no evidence of depressive disorder or depressive symptoms in only 3.5%.
The PHQ-8 diagnostic algorithm rather than an independent structured psychiatric interview was used as the criterion standard.
The PHQ-8 is a useful depression measure for population-based studies, and either its diagnostic algorithm or a cutpoint > or = 10 can be used for defining current depression.

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    • "Depression is a common mental disorder that is among the leading causes of disability world- wide[1]. Given that depressive symptoms are closely linked with depression, there has been a great interest in understanding the distribution of depressive symptoms in the general popula- tion[2,3]. However, despite the accumulation of knowledge regarding the prevalence of depressive symptoms, no mathematical model has been developed to explain the distribution of depressive symptoms in a population. "
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    ABSTRACT: Background: In a previous study, we reported that the distribution of total depressive symptoms scores according to the Center for Epidemiologic Studies Depression Scale (CES-D) in a general population is stable throughout middle adulthood and follows an exponential pattern except for at the lowest end of the symptom score. Furthermore, the individual distributions of 16 negative symptom items of the CES-D exhibit a common mathematical pattern. To confirm the reproducibility of these findings, we investigated the distribution of total depressive symptoms scores and 16 negative symptom items in a sample of Japanese employees. Methods: We analyzed 7624 employees aged 20-59 years who had participated in the Northern Japan Occupational Health Promotion Centers Collaboration Study for Mental Health. Depressive symptoms were assessed using the CES-D. The CES-D contains 20 items, each of which is scored in four grades: "rarely," "some," "much," and "most of the time." The descriptive statistics and frequency curves of the distributions were then compared according to age group. Results: The distribution of total depressive symptoms scores appeared to be stable from 30-59 years. The right tail of the distribution for ages 30-59 years exhibited a linear pattern with a log-normal scale. The distributions of the 16 individual negative symptom items of the CES-D exhibited a common mathematical pattern which displayed different distributions with a boundary at "some." The distributions of the 16 negative symptom items from "some" to "most" followed a linear pattern with a log-normal scale. Conclusions: The distributions of the total depressive symptoms scores and individual negative symptom items in a Japanese occupational setting show the same patterns as those observed in a general population. These results show that the specific mathematical patterns of the distributions of total depressive symptoms scores and individual negative symptom items can be reproduced in an occupational population.
    Full-text · Article · Jan 2016 · PLoS ONE
    • "The item is eliminated because interviewers collecting data for large­scale telephone surveys lack the resources to conduct a clinical assessment or arrange a proper intervention for respondents who express thoughts of suicide or self­harm. The PHQ­9 is a valid and reliable measure of depression consistent with DSM diagnostic criteria, and the PHQ­8 has similar operating characteris­ tics (Kroenke et al., 2009;Kroenke & Spitzer, 2002). PHQ­8 scores were determined by summing across the 8 item scores. "
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    ABSTRACT: Seasonal affective disorder (SAD) is based on the theory that some depressions occur seasonally in response to reduced sunlight. SAD has attracted cultural and research attention for more than 30 years and influenced the DSM through inclusion of the seasonal variation modifier for the major depression diagnosis. This study was designed to determine if a seasonally related pattern of occurrence of major depression could be demonstrated in a population-based study. A cross-sectional U.S. survey of adults completed the Patient Health Questionnaire–8 Depression Scale. Regression models were used to determine if depression was related to measures of sunlight exposure. Depression was unrelated to latitude, season, or sunlight. Results do not support the validity of a seasonal modifier in major depression. The idea of seasonal depression may be strongly rooted in folk psychology, but it is not supported by objective data. Consideration should be given to discontinuing seasonal variation as a diagnostic modifier of major depression.
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    • "Clinicians need to be aware of the limitations of the PHQ-9 so that these can be accounted for when interpreting patient responses, to minimize overestimation of depressive symptoms and suicidal ideation. One possible solution to the problems identified here would be to use the PHQ-8 (consisting of the first eight items of the PHQ- 9) as an alternative, validated [7] depression screener. "
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    ABSTRACT: Aims: To examine the prevalence and correlates of suicidal ideation in a community-based sample of adults with Type 1 or Type 2 diabetes. Methods: Participants were 3338 adults aged 18-70 years with Type 1 diabetes (n=1376) or Type 2 diabetes (non-insulin: n=1238; insulin: n=724) from a national survey administered to a random sample registered with the National Diabetes Services Scheme. Depression and suicidal ideation were assessed using the Patient Health Questionnaire, and diabetes-specific distress with the Problem Areas In Diabetes scale. Separate logistic regression analyses by diabetes type/treatment were used to determine relative contribution to suicidal ideation. Results: Overall, we observed a suicidal ideation rate of 14% in our sample. Participants with Type 2 diabetes using insulin reported more frequent depressive symptoms, and were more likely to report recent suicidal ideation (19%) compared with those with either Type 1 diabetes or Type 2 diabetes not using insulin (14 and 12%, respectively). After controlling for depression, there was little difference in the prevalence of suicidal ideation between diabetes types/treatments, but higher diabetes-specific distress significantly increased the odds of suicidal ideation. Conclusions: As suicidal ideation is a significant risk factor for a suicide attempt, the findings have implications for healthcare professionals, pointing to the importance of adequate screening and action plans for appropriate follow-up of those reporting depression. Our findings are also indicative of the psychological toll of diabetes more generally, and the need to integrate physical and mental healthcare for people with diabetes. This article is protected by copyright. All rights reserved.
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