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Patient health questionnaire in the general population sample - establishing the cut-off score for detecting major depression
- N. P. Maric, L. Mihic, C. Study Group
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S64-S65
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Introduction
The traditional Patient Health Questionnaire (PHQ-9) cut-off score of ≥10 has been found to balance best sensitivity and specificity when used in patient populations. Depression screening has been recommended in general population surveys, however, in comparison to patient population a few studies have suggested different optimal cut-off values to detect possible depression.
ObjectivesAim of this research involving country-representative general adult population sample was to identify which PHQ-9 cut-off score distinguishes individuals with and without depression.
MethodsThis was a cross-sectional observational epidemiological survey CoV2Soul.rs (registration number NCT04896983) using in-person interviews and multistage household probabilistic sampling in mid-2021 to recruit representative adult sample (N=1203; age 43.7 (SD 13.6); 48.7% male; mean education 12.7 (SD 2.9)). Current mental disorders were observer-rated on the Mini International Neuropsychiatric Interview (MINI Standard 7.0.2.). The PHQ-9 was self-rated by the participants and research assistants were not aware of their self-scoring. Sensitivity, specificity, and likelihood ratio tests for predicting current major depressive episode were evaluated at various cut-off points of the PHQ-9.
ResultsThe mean PHQ-9 score was 3.2 (SD 3.8). The value is highly comparable with other general population studies. At the cut-off score of 8, sensitivity was .85 and specificity was .91. At the cut-off value of 10, sensitivity dropped to .74, suggesting that the optimal cut-off score was 8. ROC analysis showed that the area under the curve was .95, indicating that the Serbian PHQ-9 can discriminate very well between persons with and without depression (Figure 1).
Table 1. Sensitivity, specificity and likelihood ratio tests at various cut-off points of the PHQ-9 Cut-offs Sensitivity Specificity LR+ LR- ≥ 5.5 .96 .82 5.33 0.05 ≥ 6.5 .89 .87 6.73 0.13 ≥ 7.5 .85 .91 9.06 0.16 ≥ 8.5 .74 .94 11.95 0.28 ≥ 9.5 .74 .96 16.84 0.27 ≥ 10.5 .63 .96 17.03 0.39 ≥ 11.5 .59 .97 21.18 0.42 ≥ 12.5 .59 .98 31.21 0.42 ConclusionsPHQ-9 is a highly useful screening tool, but the same cut-off score might not be appropriate in all settings. In European countries, studies of the general population that determine optimal cut-off PHQ-9 value against a validated interview to detect depression are rare. We demonstrated that the cut-off of ≥8 balances best its sensitivity and specificity when assessed against the structured diagnostic interview in the general population.
This work was supported by the Science Fund of the Republic of Serbia, grant number #7528289. The special research program on Covid-19 is financed by a World Bank loan through Serbia Accelerating Innovation and Entrepreneurship Project – SAIGE.
Disclosure of InterestNone Declared
Covid-19-related stressors, mental disorders, depressive and anxiety symptoms: a cross-sectional, nationally-representative, face-to-face survey in Serbia
- N. P. Marić, L. J. B. Lazarević, S. Priebe, L. J. Mihić, M. Pejović-Milovančević, Z. Terzić-Šupić, O. Tošković, O. Vuković, J. Todorović, G. Knežević
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 31 / 2022
- Published online by Cambridge University Press:
- 24 May 2022, e36
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Aim
The Covid-19 pandemic may be associated with an increase in mental disorders and mental distress. However, there are no representative studies testing the impact of stressors directly related to Covid-19. We aimed to determine whether Covid-19-related stressors were associated with mental disorders, depressive and anxiety symptoms in the second year of the pandemic.
MethodThis cross-sectional observational epidemiological survey was conducted from June to October 2021. We interviewed a representative sample of the adult population in Serbia (18–65 years) in the second year of the pandemic, at a time when large parts of the population had been affected by the pandemic in different ways. A multistage probabilistic household sampling of the adult population in 60 municipalities was used. Mental disorders were assessed by in-person interviews using the Mini International Neuropsychiatric Interview. Depressive and anxiety symptoms were measured by PHQ-9 and GAD-7 scales. Covid-19-related stressors (Sars-CoV-2 infection, the infection of a close relative, self-isolation and lack of protective equipment at work), as well as other stressors during the pandemic (not directly related to the risk of the infection), were measured. The associations with mental disorders, depressive and anxiety symptoms were explored through univariable and multivariable regression analyses.
ResultsIn total, 1203 individuals (mean age 43.7 ± 13.6 years, 48.7% male) were interviewed. Most respondents (67.8%) of the sample had already experienced Covid-19-related stressors (20.1% had Sars-CoV-2 infection; 43.2% had a close relative member who had Covid-19; 28.2% reported lack of appropriate protection; 27.5% had been quarantined) and about 50% had already been vaccinated. The prevalence of any mental disorder was 15.2% (95% CI 13.2–17.2): mood disorders 4.6%, anxiety disorders 4.3% and substance use disorders 8.0%. Mean PHQ-9 was 3.2 ± 3.8 and GAD-7 was 2.1 ± 3.1. In this study, one Covid-19 stressor, i.e. lack of protective equipment, was weakly associated with a greater frequency of anxiety disorders (p = 0.023), while the other stressors had significant associations with several groups of mental disorders and symptom levels.
ConclusionsOur study did not provide any evidence that the prevalence of mental disorders exceeds the range of pre-pandemic data reported in the literature. Covid-related stressors, although frequently reported, did not dramatically influence the prevalence of mental disorders. The provision of the appropriate equipment at workplaces might lead to the reduction of anxiety disorders.