Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal
Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal
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DOI：
10.1186/s12888-016-0768-y
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发表时间：
2016-03-08
期刊：
影响因子：
4.4
通讯作者：
Jordans, Mark J. D.
中科院分区：
文献类型：
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作者：
Kohrt, Brandon A.;Luitel, Nagendra P.;Jordans, Mark J. D.
背景：尽管在低收入和中等收入国家，人们认识到情绪障碍造成的疾病负担，但在检测抑郁症的最佳实践上缺乏共识。自我报告筛查工具，如患者健康问卷(PHQ-9)，需要针对低识字率人群进行修改，以确保文化和临床有效性。另一种方法是使用当地突出的痛苦习语，但这些习语并不是精神病学类别的同义词。因此，我们的目标是评估PHQ-9的效度，评估使用痛苦成语的附加值，并开发一种在初级护理中发现抑郁的算法。方法：我们用定性的方法对PHQ-9在尼泊尔进行了跨文化翻译，以实现语义、内容、技术和标准的对等。研究人员对一家农村初级卫生保健中心随机选择的患者进行了尼泊尔PHQ-9测试。受过培训的心理社会咨询师进行了尼泊尔综合国际诊断访谈(CIDI)中有效的尼泊尔抑郁症模块的验证，以验证尼泊尔PHQ-9。结果：在125名初级保健患者中，17名(14%)在CIDI治疗的前两周内有严重的抑郁发作。以尼泊尔PHQ-9为界值10：敏感度=0.94，特异度=0.80，阳性预测值(PPV)=0.42，阴性预测值(NPV)=0.99，阳性似然比=4.62，阴性似然比=0.07。心脑血管疾病：灵敏度=0.94，特异度=0.27，PPV=0.17，NPV=0.97。使用包含两个筛查问题(1.心智问题的存在和2.心智问题所致的功能损害)的算法来确定谁应该接受完整的PHQ-9，需要接受PHQ-9的患者数量可以减少50%，PHQ-9的假阳性将减少18%，88%的抑郁症患者将被正确识别。结论：结合苦恼习语和跨文化翻译的抑郁症筛查器提高了效率，并保持了高水平检测的准确性。该算法减少了初级保健人员为识字能力有限的患者口头管理该工具所需的时间。假阳性的负担与高收入国家的比率相当，是普遍初级保健筛查的限制。
Background: Despite recognition of the burden of disease due to mood disorders in low- and middle-income countries, there is a lack of consensus on best practices for detecting depression. Self-report screening tools, such as the Patient Health Questionnaire (PHQ-9), require modification for low literacy populations and to assure cultural and clinical validity. An alternative approach is to employ idioms of distress that are locally salient, but these are not synonymous with psychiatric categories. Therefore, our objectives were to evaluate the validity of the PHQ-9, assess the added value of using idioms of distress, and develop an algorithm for depression detection in primary care.Methods: We conducted a transcultural translation of the PHQ-9 in Nepal using qualitative methods to achieve semantic, content, technical, and criterion equivalence. Researchers administered the Nepali PHQ-9 to randomly selected patients in a rural primary health care center. Trained psychosocial counselors administered a validated Nepali depression module of the Composite International Diagnostic Interview (CIDI) to validate the Nepali PHQ-9. Patients were also assessed for local idioms of distress including heart-mind problems (Nepali, manko samasya).Results: Among 125 primary care patients, 17 (14 %) were positive for a major depressive episode in the prior 2 weeks based on CIDI administration. With a Nepali PHQ-9 cutoff >= 10: sensitivity =0.94, specificity =0.80, positive predictive value (PPV) =0.42, negative predictive value (NPV) =0.99, positive likelihood ratio =4.62, and negative likelihood ratio =0.07. For heart-mind problems: sensitivity =0.94, specificity =0.27, PPV =0.17, NPV =0.97. With an algorithm comprising two screening questions (1. presence of heart-mind problems and 2. function impairment due to heart-mind problems) to determine who should receive the full PHQ-9, the number of patients requiring administration of the PHQ-9 could be reduced by 50 %, PHQ-9 false positives would be reduced by 18 %, and 88 % of patients with depression would be correctly identified.Conclusion: Combining idioms of distress with a transculturally-translated depression screener increases efficiency and maintains accuracy for high levels of detection. The algorithm reduces the time needed for primary healthcare staff to verbally administer the tool for patients with limited literacy. The burden of false positives is comparable to rates in high-income countries and is a limitation for universal primary care screening.