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J Affect Disord. 2014;167:160-6. doi: 10.1016/j.jad.2014.06.003. Epub 2014 Jun 12.

Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa.

Author information

1
Department of Epidemiology, UNC Gillings School of Global Public Health, McGavran-Greenberg Hall, 135 Dauer Drive, Chapel Hill, NC 27599, USA. Electronic address: rcholera@med.unc.edu.
2
Department of Psychiatry, UNC School of Medicine, USA.
3
Department of Epidemiology, UNC Gillings School of Global Public Health, McGavran-Greenberg Hall, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
4
Collaborative Research Network for Mental Health and Well-being in Rural Communities, University of New England, Armidale, Australia & Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
5
Witkoppen Health and Welfare Center, Johannesburg, South Africa.
6
Department of Epidemiology, UNC Gillings School of Global Public Health, McGavran-Greenberg Hall, 135 Dauer Drive, Chapel Hill, NC 27599, USA; Department of Medicine, UNC School of Medicine, USA.

Abstract

BACKGROUND:

Integration of depression screening into primary care may increase access to mental health services in sub-Saharan Africa, but this approach requires validated screening instruments. We sought to validate the Patient Health Questionnaire-9 (PHQ-9) as a depression screening tool at a high HIV-burden primary care clinic in Johannesburg, South Africa.

METHODS:

We conducted a validation study of an interviewer-administered PHQ-9 among 397 patients. Sensitivity and specificity of the PHQ-9 were calculated with the Mini International Neuropsychiatric Interview (MINI) as the reference standard; receiver operating characteristic (ROC) curve analyses were performed.

RESULTS:

The prevalence of depression was 11.8%. One-third of participants tested positive for HIV. HIV-infected patients were more likely to be depressed (15%) than uninfected patients (9%; p=0.08). Using the standard cutoff score of ≥10, the PHQ-9 had a sensitivity of 78.7% (95% CI: 64.3-89.3) and specificity of 83.4% (95% CI: 79.1-87.2). The area under the ROC curve was 0.88 (95% CI: 0.83-0.92). Test performance did not vary by HIV status or language. In sensitivity analyses, reference test bias associated with the MINI appeared unlikely.

LIMITATIONS:

We were unable to conduct qualitative work to adapt the PHQ-9 to this cultural context.

CONCLUSION:

This is the first validation study of the PHQ-9 in a primary care clinic in sub-Saharan Africa. It highlights the potential for using primary care as an access point for identifying depressive symptoms during routine HIV testing. The PHQ-9 showed reasonable accuracy in classifying cases of depression, was easily implemented by lay health workers, and is a useful screening tool in this setting.

KEYWORDS:

Africa; Depression; HIV; Screening; Validation study

PMID:
24972364
PMCID:
PMC4264106
DOI:
10.1016/j.jad.2014.06.003
[Indexed for MEDLINE]
Free PMC Article

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