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Validity and item response theory properties of the Patient Health Questionnaire-9 for primary care depression screening in Mozambique (PHQ-9-MZ).
Cumbe, Vasco F J; Muanido, Alberto; Manaca, Maria Nélia; Fumo, Hélder; Chiruca, Pedro; Hicks, Leecreesha; de Jesus Mari, Jair; Wagenaar, Bradley H.
Afiliação
  • Cumbe VFJ; Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique. vcumbe@gmail.com.
  • Muanido A; Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. vcumbe@gmail.com.
  • Manaca MN; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique. vcumbe@gmail.com.
  • Fumo H; Health Alliance International, Beira, Mozambique.
  • Chiruca P; Health Alliance International, Beira, Mozambique.
  • Hicks L; Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique.
  • de Jesus Mari J; Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique.
  • Wagenaar BH; Health Alliance International, Seattle, WA, USA.
BMC Psychiatry ; 20(1): 382, 2020 07 22.
Article em En | MEDLINE | ID: mdl-32698788
ABSTRACT

BACKGROUND:

Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique.

METHODS:

The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool.

RESULTS:

The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach's alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%.

CONCLUSIONS:

The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transtorno Depressivo Maior / Questionário de Saúde do Paciente Tipo de estudo: Diagnostic_studies / Prognostic_studies / Qualitative_research / Screening_studies Limite: Female / Humans / Pregnancy País/Região como assunto: Africa Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transtorno Depressivo Maior / Questionário de Saúde do Paciente Tipo de estudo: Diagnostic_studies / Prognostic_studies / Qualitative_research / Screening_studies Limite: Female / Humans / Pregnancy País/Região como assunto: Africa Idioma: En Ano de publicação: 2020 Tipo de documento: Article