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Gen Hosp Psychiatry. 2017 Sep;48:25-31. doi: 10.1016/j.genhosppsych.2017.06.006. Epub 2017 Jun 15.

The prevalence of depression and the accuracy of depression screening tools in migraine patients.

Author information

1
Dept of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Canada. Electronic address: farnaz.amoozegar@albertahealthservices.ca.
2
Hotchkiss Brain Institute, Canada; Dept of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Dept of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Canada.
3
Dept of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Canada.
4
Dept of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Canada; Dept of Medical Genetics, University of Calgary, Calgary, Alberta, Canada.
5
Dept of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
6
Dept of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Canada; Dept of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Canada.

Abstract

OBJECTIVES:

Migraine and depression are common comorbid conditions. The purpose of this study was to assess how well the Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS) perform as depression screening tools in patients with migraine.

METHODS:

Three hundred consecutive migraine patients were recruited from a large headache center. The PHQ-9 and HADS were self-administered and validated against the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV, a gold standard for the diagnosis of depression. Sensitivity, specificity, positive predictive value, negative predictive value and receiver-operator characteristic curves were calculated for the PHQ-9 and HADS.

RESULTS:

At the traditional cut-point of 10, the PHQ-9 demonstrated 82.0% sensitivity and 79.9% specificity. At a cut-point of 8, the HADS demonstrated 86.5% sensitivity and specificity. The PHQ-9 algorithm performed poorly (53.8% sensitivity, 94.9% specificity). The point prevalence of depression in this study was 25.0% (95% CI 19.0-31.0), and 17.0% of patients had untreated depression.

CONCLUSIONS:

In this study, the PHQ-9 and HADS performed well in migraine patients attending a headache clinic, but optimal cut-points to screen for depression vary depending on the goals of the assessment. Also, migraine patients attending a headache clinic have a high prevalence of depression and many are inadequately treated. Future studies are needed to confirm these findings and to evaluate the impact of depression screening.

KEYWORDS:

Depression; Migraine; Prevalence; Screening; Sensitivity; Specificity

[Indexed for MEDLINE]

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