Evaluation of the PHQ-9 Item 3 as a screen for sleep disturbance in primary care

Abstract

Background: Sleep disturbance is a significant problem for adults presenting to primary care. Though it is recommended that primary care providers screen for sleep problems, a brief, effective screening tool is not available.

Objective: The aim of this preliminary study was to test the utility of item three of the Patient Health Questionnaire-9-item (PHQ-9) as a self-report screening test for sleep disturbance in primary care.

Design: This was a cross-sectional survey of male VA primary care patients in Syracuse and Rochester, NY. Sensitivity and specificity statistics were calculated as well as positive and negative predictive value to determine both whether the PHQ-9 item-3 can be used as an effective sleep screen in primary care and at what PHQ item-3 cut score patients should be further assessed for sleep disturbance.

Participants: One hundred and eleven male, VA primary care patients over the age of 18 and without gross neurological impairment participated in this one-session, in-person study.

Measures: During the research session, patients completed several questionnaires, including a basic demographic questionnaire, the PHQ-9, and the Insomnia Severity Index (ISI).

Key results: PHQ-9 item 3 significantly correlated with the total score on the ISI (r = 0.75, p < 0.0001). A cut score of 1 on the PHQ-9 item 3, indicating sleep disturbance at least several days in the last two weeks, showed the best balance of sensitivity (82.5%) and specificity (84.5%) as well as positive (78.4%) and negative (91%) predictive value.

Conclusions: Item 3 of the PHQ-9 shows promise as a screener for sleep problems in primary care. Using this one-item of a popular screening measure for depression in primary care allows providers to easily screen for two important issues without unnecessarily adding significant burden.

Figure 1

Area under the receiver operating curve.