Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury

J Head Trauma Rehabil. 2005 Nov-Dec;20(6):501-11. doi: 10.1097/00001199-200511000-00003.


Objective: To test the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) for diagnosing major depressive disorder (MDD) among persons with traumatic brain injury (TBI).

Design: Prospective cohort study.

Setting: Level I trauma center.

Participants: 135 adults within 1 year of complicated mild, moderate, or severe TBI.

Main outcome measures: PHQ-9 Depression Scale, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID).

Results: Using a screening criterion of at least 5 PHQ-9 symptoms present at least several days over the last 2 weeks (with one being depressed mood or anhedonia) maximizes sensitivity (0.93) and specificity (0.89) while providing a positive predictive value of 0.63 and a negative predictive value of 0.99 when compared to SCID diagnosis of MDD. Pearson's correlation between the PHQ-9 scores and other depression measures was 0.90 with the Hopkins Symptom Checklist depression subscale and 0.78 with the Hamilton Rating Scale for Depression. Test-retest reliability of the PHQ-9 was r = 0.76 and kappa = 0.46 when using the optimal screening method.

Conclusions: The PHQ-9 is a valid and reliable screening tool for detecting MDD in persons with TBI.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Adult
  • Age Distribution
  • Brain Injuries / complications*
  • Brain Injuries / diagnosis
  • Cohort Studies
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / etiology
  • Female
  • Follow-Up Studies
  • Glasgow Coma Scale
  • Humans
  • Incidence
  • Injury Severity Score
  • Male
  • Middle Aged
  • Probability
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sex Distribution
  • Surveys and Questionnaires*