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Screening for depression in low-income elderly patients at the primary care level: use of the patient health questionnaire-2.

Lino VT, Portela MC, Camacho LA, Atie S, Lima MJ, Rodrigues NC, Barros MB, Andrade MK - PLoS ONE (2014)

Bottom Line: The simplicity of the PHQ-2 is an advantage for its use in PC.The high NPV indicated that 90% of those who tested negative would not need additional tests.The application of the instrument could be the first step of the screening, that would include a second step to all those with positive tests formerly.

View Article: PubMed Central - PubMed

Affiliation: National Public Health School/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

ABSTRACT

Introduction: Depression is one of the most common mental disorders and a leading cause of disability worldwide. It constitutes a serious public health problem, particularly among elderly individuals. Most depressed elderly patients are treated by primary care (PC) physicians. The "Patient Health Questionnaire" (PHQ-2) is an instrument used for the detection of depression in PC settings.

Objective: Evaluate the performance of the PHQ-2 in a low-income and uneducated elderly PC population.

Methods: A non-probabilistic population sample of 142 individuals was selected from the healthcare unit's users ≧ 60 years. Criterion validity was assessed by estimating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PHQ-2 in comparison with the structured interview using the DSM-IV. The estimates of sensitivity and specificity were obtained from varying cut-offs of the PHQ-2 score. A Receiver Operator Characteristic (ROC) curve was constructed and the area under the curve (AUC) was calculated.

Results: The group was predominantly female (73.9%), with low education level (mean 3 years of schooling). The mean age was 72.5 years old. The prevalence of depression was 26.1%. The best values of sensitivity (0.74), specificity (0.77), PPV (0.50) e NPV (0.90) were obtained with score equal to 1. The AUC was 0.77, indicating a modest performance of the test accuracy.

Conclusion: The simplicity of the PHQ-2 is an advantage for its use in PC. The high NPV indicated that 90% of those who tested negative would not need additional tests. However, the low PPV indicated that the PHQ-2 is not sufficient to screen for depression. The application of the instrument could be the first step of the screening, that would include a second step to all those with positive tests formerly.

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Related in: MedlinePlus

ROC curve of predictive logistic regression model for depression according to the scores of the PHQ – 2.
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pone-0113778-g001: ROC curve of predictive logistic regression model for depression according to the scores of the PHQ – 2.

Mentions: The results of the analysis of the psychometric properties of the PHQ-2 indicated that the values for sensitivity declined as the score value increased. (Table 2; Figure 1). For these values, the PPV indicated that depression in 50% of those with a positive test was not confirmed. However, the corresponding result of NPV = 0.90 indicated that 10% of those with negative test results had a false negative diagnosis of depression.


Screening for depression in low-income elderly patients at the primary care level: use of the patient health questionnaire-2.

Lino VT, Portela MC, Camacho LA, Atie S, Lima MJ, Rodrigues NC, Barros MB, Andrade MK - PLoS ONE (2014)

ROC curve of predictive logistic regression model for depression according to the scores of the PHQ – 2.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4256208&req=5

pone-0113778-g001: ROC curve of predictive logistic regression model for depression according to the scores of the PHQ – 2.
Mentions: The results of the analysis of the psychometric properties of the PHQ-2 indicated that the values for sensitivity declined as the score value increased. (Table 2; Figure 1). For these values, the PPV indicated that depression in 50% of those with a positive test was not confirmed. However, the corresponding result of NPV = 0.90 indicated that 10% of those with negative test results had a false negative diagnosis of depression.

Bottom Line: The simplicity of the PHQ-2 is an advantage for its use in PC.The high NPV indicated that 90% of those who tested negative would not need additional tests.The application of the instrument could be the first step of the screening, that would include a second step to all those with positive tests formerly.

View Article: PubMed Central - PubMed

Affiliation: National Public Health School/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

ABSTRACT

Introduction: Depression is one of the most common mental disorders and a leading cause of disability worldwide. It constitutes a serious public health problem, particularly among elderly individuals. Most depressed elderly patients are treated by primary care (PC) physicians. The "Patient Health Questionnaire" (PHQ-2) is an instrument used for the detection of depression in PC settings.

Objective: Evaluate the performance of the PHQ-2 in a low-income and uneducated elderly PC population.

Methods: A non-probabilistic population sample of 142 individuals was selected from the healthcare unit's users ≧ 60 years. Criterion validity was assessed by estimating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PHQ-2 in comparison with the structured interview using the DSM-IV. The estimates of sensitivity and specificity were obtained from varying cut-offs of the PHQ-2 score. A Receiver Operator Characteristic (ROC) curve was constructed and the area under the curve (AUC) was calculated.

Results: The group was predominantly female (73.9%), with low education level (mean 3 years of schooling). The mean age was 72.5 years old. The prevalence of depression was 26.1%. The best values of sensitivity (0.74), specificity (0.77), PPV (0.50) e NPV (0.90) were obtained with score equal to 1. The AUC was 0.77, indicating a modest performance of the test accuracy.

Conclusion: The simplicity of the PHQ-2 is an advantage for its use in PC. The high NPV indicated that 90% of those who tested negative would not need additional tests. However, the low PPV indicated that the PHQ-2 is not sufficient to screen for depression. The application of the instrument could be the first step of the screening, that would include a second step to all those with positive tests formerly.

Show MeSH
Related in: MedlinePlus