Comparison of two self-rating scales to detect depression: HADS and PHQ-9
Comparison of two self-rating scales to detect depression: HADS and PHQ-9
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DOI：
10.3399/bjgp09x454070
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发表时间：
2009-09-01
影响因子：
5.9
通讯作者：
Bodlund, Owe
中科院分区：
文献类型：
--
作者：
Hansson, Maja;Chotai, Jayanti;Bodlund, Owe
超过一半的抑郁症患者未被发现。自评量表可用于筛查抑郁症，并测量严重程度和治疗outcome.Aim本研究比较了医院焦虑和抑郁量表（HADS）和患者健康问卷（PHQ-9）的心理测量学特性，方法瑞典初级保健患者和精神科门诊患者（n = 737）报告有抑郁症状的人完成了自我评定量表。数据收集自2006年至2007年。内部一致性，因素分析，并在建议cutoffs. Results的协议（科恩的kappa）方面进行了分析，这两个规模有较高的内部一致性（α = 0.9）和稳定的因素结构。使用严重性截止值，PHQ-9（>= 5）诊断的患者比HADS抑郁子量表（HADS-D; >= 8）多30%。他们认为轻度和中度抑郁症的患病率相同，但与重度抑郁症的患病率不同。当比较推荐的筛选截止值时，HADS-D >= 11（33.5%的参与者）和PHQ-9 >= 10（65.9%）的一致性较低（kappa = 0.35）。使用HADS-D中推荐的下限临界值（>= 8），与PHQ-9 >= 10的一致性为中等（kappa = 0.52）。HADS-D >= 8与PHQ-9 >= 12比较，发现一致性最高（kappa = 0.56）。结论HADS和PHQ-9均为快速、可靠的量表。HADS的优点是可以同时评估抑郁和焦虑，而PHQ-9则严格基于《精神障碍诊断和统计手册》。尽管确定的患病率相似，但在最佳适当临界值的量表之间的一致性是中等的。这表明，这些比例表没有完全确定相同的情况。这种差异需要进一步探讨。
Background More than half of patients with depression go undetected. Self-rating scales can be useful in screening for depression, and measuring severity and treatment outcome.Aim This study compares the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) with regard to their psychometric properties, and investigates their agreement at different cut-off scores.Method Swedish primary care patients and psychiatric outpatients (n = 737) who reported symptoms of depression completed the self-rating scales. Data were collected from 2006 to 2007. Analyses with respect to internal consistency, factor analysis, and agreement (Cohen's kappa) at recommended cut-offs were performed.Results Both scales had high internal consistency (alpha = 0.9) and stable factor structures. Using severity cut-offs, the PHQ-9 (>= 5) diagnosed about 30% more patients than the HADS depression subscale (HADS-D; >= 8). They recognised the same prevalence of mild and moderate depression, but differed in relation to severe depression. When comparing recommended screening cut-offs, HADS-D >= 11 (33.5% of participants) and PHQ-9 >= 10 (65.9%) agreement was low (kappa = 0.35). Using the lower recommended cut-off in the HADS-D (>= 8), agreement with PHQ-9 >= 10 was moderate (kappa = 0.52). The highest agreement (kappa = 0.56) was found comparing HADS-D >= 8 with PHQ-9 >= 12. This also equalised the prevalence of depression found by the scales.Conclusion The HADS and PHQ-9 are both quick and reliable. The HADS has the advantage of evaluating both depression and anxiety, and the PHQ-9 of being strictly based upon the Diagnostic and Statistical Manual of Mental Disorders. The agreement between the scales at the best suitable cut-off is moderate, although the identified prevalence was similar. This indicates that the scales do not fully identify the same cases. This difference needs to be further explored.