Abstract
Objective
To examine the performance of the Patient Health Questionnaire‐2 (PHQ‐2) and the PHQ‐9 in detecting current major depressive episode (MDE) in aging services care management clients who screen positive for cognitive impairment (CI).
Methods
Cross‐sectional observational study of 236 care management clients ages ≥60 years recruited from an Upstate NY aging services agency. The test characteristics of the PHQ‐2 and PHQ‐9 to screen for depression were calculated using the Structured Clinical Interview for DSM‐IV (SCID) to identify MDE (gold standard). CI was identified with the Six‐Item Screen (SIS).
Results
Participants had a mean age of 77 years, 68% female, 16% non‐white, and 26% had less than a high school education. 16% of participants had CI identified by ≥2 errors on SIS. Of these, 41% had positive PHQ‐2 (scores ≥3), 43% had positive PHQ‐9 (scores ≥10), while 24% met criteria for MDE. In the sample with CI, the PHQ‐2, using a cutoff of 3, had sensitivity = 0.78, specificity = 0.71, and receiver operating characteristic (ROC) area under the curve (AUC) = 0.81, compared with 0.79, 0.82, and 0.88, respectively, for those without CI. In the sample with CI, the PHQ‐9, using a cutoff of 10, had sensitivity = 0.89, specificity = 0.71, and AUC = 0.85, compared with 0.85, 0.89, and 0.91, respectively, for those without CI.
Conclusions
Cognitive status should be considered when using the PHQ as a depression screener due to poorer specificity in seniors with CI. Copyright © 2010 John Wiley & Sons, Ltd.