Post Stroke Depression: Clinimetric Properties of the Patient Health Questionnaire

Hafsteinsdottir, Thora

Monday, 22 July 2013: 1:50 PM

Janneke Man-van Ginkel, RN, PhD
Department of Rehabilitation Nursing Science and Sport, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, Netherlands
Thora Hafsteinsdottir, RN, PhD
Department of Rehabilitation, Nursing Science and Sport, Rudolph Magnus Institute of Neuroscience, University Medical Center, Utrecht, Utrecht, Netherlands
Floor Gooskes, RN, MSc
Department of Psychiatry, University Medical Center Utrecht., Utrecht, Netherlands
Vera Schepers, MD, PhD
Department of Rehabilitation Nursing Science and Sport, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, the Netherlands, Utrecht, Netherlands
Eline Lindeman, MD, PhD
Department of Rehabilitation and Sportsmedicine, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, Netherlands
Huibert Burger, MD, PhD
Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands
Diederick Grobbee, MD, PhD
Julius Center for Health Care Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
Marieke Schuurmans, RN, PhD
Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, Utrecht, The Netherlands, 3508 AB Utrecht, Netherlands

Learning Objective 1: The learner will be able to know the importance of early screening and detection of depression in patients with stroke.

Learning Objective 2: The learner will be able to use the PHQ-9 for early screening and detection of depression in patients with stroke in various settings.

Purpose: Study 1: To investigate the clinimetric properties of the 9 items and 2 items Patients Health Questionnaire in nursing practice of stroke patients compared with the Geriatric Depression Scale. Study2: To investigate the diagnostic value of the 9-item and the 2-item PHQ.

Methods: Study 1: Depression was measured in stroke patients (n=55), able to communicate using the PHQ-9. The inter-rater reliability, test-retest reliability, internal consistency, concurrent validity, diagnostic accuracy and clinical utility were evaluated. Study 2: Depression was measured in patients (n=171) in week 6-8 after stroke using the PHQ-2 and PHQ-9 and diagnosed with the Composite International Diagnostic Interview (CIDI).

Results: Study 1: The inter-rater reliability (ICC = 0.98), the test-retest reliability (ρSp = 0.75, p<0.001) and the internal consistency (Cronbach’s α = 0.79) of the PHQ-9 were good. The concurrent validity was moderate for the PHQ-9, and acceptable for the PHQ-2. The optimum cut-off point of the PHQ-9 for major depression was 10 (sensitivity, 100%; specificity, 86%; positive predicted value, 50%; negative predicted value, 100%). For the PHQ-2 it was 2 (sensitivity, 100%; specificity, 77%; positive predicted value, 38% and negative predicted value, 100%). Study 2: The PHQ-9 performed best at a score ≥10 (sensitivity: 0,80, specificity: 0.79) and the PHQ-2 at a score ≥2 (sensitivity: 0.75, specificity: 0.76). Administering the PHQ-9 only to patients who scored ≥2 on the PHQ-2 improved the identification of depression.

Conclusion: The PHQ is a brief and easy-to-use instrument showing good clinimetric properties for patients with stroke able to communicate. The diagnostic value for scores of ≥10 (PHQ-9) and ≥2 PHQ-2, but conducting a PHQ-9 only in patients with a PHQ-2 score ≥ 2 generates the best results. Based on these findings the PHQ can be recommended for nurses to use for the early detection of depression in patients with stroke.

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