People with diabetes need a lower cut-off than others for depression screening with PHQ-9

Ewelina Cichoń; Andrzej Kiejna; Andrzej Kokoszka; Tomasz M Gondek; Rafał Radzio; Adam Jastrzębski; Beata E Andrzejewska; Fahad D Alosaimi; Cathy E Lloyd; Norman Sartorius

doi:10.1371/journal.pone.0240209

People with diabetes need a lower cut-off than others for depression screening with PHQ-9

PLoS One. 2020 Oct 23;15(10):e0240209. doi: 10.1371/journal.pone.0240209. eCollection 2020.

Authors

Ewelina Cichoń^{1

2}, Andrzej Kiejna^{1

2}, Andrzej Kokoszka³, Tomasz M Gondek^{4

5}, Rafał Radzio³, Adam Jastrzębski⁶, Beata E Andrzejewska^{1

2}, Fahad D Alosaimi⁷, Cathy E Lloyd⁸, Norman Sartorius⁹

Affiliations

¹ Department of Psychology, WSB University in Toruń, Toruń, Poland.
² Department of Psychology, Faculty of Education, Psychology Research Unit for Public Health, University of Lower Silesia, Wroclaw, Poland.
³ II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
⁴ Specialty Training Section, Polish Psychiatric Association, Wrocław, Poland.
⁵ Section on Education, World Psychiatric Association, Wrocław, Poland.
⁶ Institute of Psychotherapy Mind Med Warsaw, Warsaw, Poland.
⁷ Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.
⁸ Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom.
⁹ Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland.

Abstract

Aims: This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and 'MDD and/or dysthymia' in people with and without type 2 diabetes.

Methods: Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden's index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice.

Results: The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden's index and ≥ 5 by the two-stage method for screening for MDD and 'MDD and/or dysthymia' in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and 'MDD and/or dysthymia' among people without diabetes (Youden's index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for 'MDD and/or dysthymia' in people without diabetes.

Conclusions: A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Depressive Disorder, Major / diagnosis*
Depressive Disorder, Major / etiology
Diabetes Complications / psychology*
Diabetes Mellitus, Type 2 / complications*
Female
Humans
Male
Middle Aged
Patient Health Questionnaire*
Poland
Reproducibility of Results

Grants and funding

This study was carried out under the aegis of the Association for the Improvement of Mental Health Programmes (AIMH) and supported by AIMH and the collaborating institutions. The investigators of the study from Poland have not received any funding. The meetings of the investigators and data entry were in part supported by unrestricted grants by Eli Lilly and Sanofi companies.