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Screening for depression in primary care: a Rasch analysis of the PHQ-9

  • Mike Horton (a1) and Amanda E. Perry (a2)
Abstract
Aims and method

To explore the modern psychometric properties of the Patient Health Questionnaire (PHQ-9), we used the Rasch analysis in a sample of 767 primary care patients with depression.

Results

The analysis highlighted dependency issues between items 1 and 2 (‘Little interest or pleasure in doing things’ and ‘Feeling down, depressed, or hopeless’), and items 3 and 4 (‘Trouble falling or staying asleep, or sleeping too much’ and ‘Feeling tired or having little energy’). Items 1 and 2 displayed an over-discrimination, suggesting their potential redundancy within the complete item set.

Clinical implications

In its current format the PHQ-9 displays some problems with regard to its measurement structure among a sample of primary care patients. These problems can be addressed by removing potentially redundant items to deliver a stable screening tool. The results also lend support for the PHQ-2 to be used as a screening tool in a primary care setting.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Amanda E. Perry (amanda.perry@york.ac.uk)
Footnotes
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See invited commentary, pp. 243–244, this issue.

Declaration of interest

None.

Footnotes
References
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Screening for depression in primary care: a Rasch analysis of the PHQ-9

  • Mike Horton (a1) and Amanda E. Perry (a2)
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