Comparative Efficacy of the Generalized Anxiety Disorder 7-Item Scale and the Edinburgh Postnatal Depression Scale as Screening Tools for Generalized Anxiety Disorder in Pregnancy and the Postpartum Period

Objective:

About 24.1% of pregnant women suffer from at least 1 anxiety disorder, 8.5% of whom suffer specifically from generalized anxiety disorder (GAD). GAD is often associated with major depressive disorder (MDD). During the perinatal period, the presence of physical and somatic symptoms often makes differentiation between depression and anxiety more challenging. To date, no screening tools have been developed to detect GAD in the perinatal population. We investigated the psychometric properties of the GAD 7-item Scale (GAD-7) as a screening tool for GAD in pregnant and postpartum women.

Methods:

Two hundred and forty perinatal women (n = 155 pregnant and n = 85 postpartum) referred for psychiatric consultation were enrolled. On the day of initial assessment, all women completed the GAD-7 and the Edinburgh Postnatal Depression Scale (EPDS). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–based diagnoses were made by experienced psychiatrists. Scores from the GAD-7 and EPDS were compared with the clinical diagnoses to evaluate the psychometric properties of the GAD-7 and EPDS when used as a screening tool for GAD.

Results:

The GAD-7 yielded a sensitivity of 61.3% and specificity of 72.7% at an optimal cut-off score of 13. Compared with the EPDS and the EPDS-3A subscale, the GAD-7 displayed greater accuracy and specificity over a greater range of cut-off scores and more accurately identified GAD in patients with comorbid MDD.

Conclusion:

Our findings suggest that the GAD-7 represents a clinically useful scale for the detection of GAD in perinatal women.     

Generalized Anxiety Disorder 7-Item (GAD-7) Scores in Medically Authorized Cannabis Patients—Ontario and Alberta,Canada

ObjectivesDespite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada.MethodsAn observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening—over time.ResultsA total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change −0.23 (95% CI, −0.28 to −0.17, t[5,074]: −8.19, p-value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores.ConclusionsOverall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6–12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.     

Behavioral Activation in Nursing Homes to Treat Depression (BAN-Dep): Results From a Clustered,Randomized, Single-Blinded,Controlled Clinical Trial

ObjectivesTo determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs).MethodsClustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8–12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interestResultsWe recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61–100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11–1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02–0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%).ConclusionsDisruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.     

Cultural-based biases of the GAD-7

The GAD-7 is a popular measure of generalized anxiety disorder (GAD) symptoms that has been used across many cultural groups. Existing evidence demonstrates that the prevalence of GAD varies across self-identified ethnic/cultural groups, a phenomenon that some researchers attribute to cross-cultural measurement error rather than to actual differences in rates of GAD. Nonetheless, the effect of culture on factor structure and response patterns to the GAD-7 have not been examined and could result over- or under-estimated GAD-7 scores across different cultural groups. The current investigation assessed the factor structure of the GAD-7 in White/Caucasian, Hispanic, and Black/African American undergraduates and tested for cultural-based biases. A modified one-factor model exhibited good fit across subsamples. Results revealed that Black/African American participants with high GAD symptoms scored lower on the GAD-7 than other participants with similar GAD symptoms. Results highlight the need for culturally sensitive GAD screening tools.     

综合心理干预对社区慢性病患者的效果评价：一项源于社区的整群、随机、对照试验

背景：抑郁与焦虑经常出现在慢性躯体疾病患者中,通常这会加深这些躯体疾病所造成的损失,但是在中低等收入国家中这一问题却很少受到关注。
　　目标：评估非专业临床人员和志愿者进行以社区为基础的心理干预对缓解慢性躯体疾病患者抑郁和焦虑症状的疗效。
　　方法：将共计10,164名接受糖尿病或高血压治疗的上海社区居民任意分配到常规治疗组(n=2042)或干预组(n=8122),对干预组的干预包括社区范围的心理健康教育、同伴支持小组和个人咨询。采用自评患者健康问卷(Paitent Health Quesitonnaire, PHQ-9)、广泛性焦虑量表(Generalized Anxiety Disorder scale, GAD-7)和12项健康状况调查问卷(12-item Short-Form Health Survey, SF-12)来评定基线和干预6个月后的抑郁症状、焦虑症状和生活质量。
　　结果：8813人完成了基线评估,其中16%的人有轻度或较严重的抑郁或焦虑症状（PHQ-9或GAD-7>5）,并有4%的人伴有中度或重度抑郁或焦虑症状（PHQ-9或GAD-7>10）。本研究有效实施了干预内容中的健康教育部分,但是在符合条件成为同伴支持小组的成员中仅31%的对象接受了干预措施,接受个人咨询的仅9%。本研究脱落率较高(51%),并且在完成和没有完成随访评估的人群之间存在显著差异。经过这些混杂因素的调整后,在完成两项评估的对象中,结果表明抑郁症状(F=9.98, p<0.001)、焦虑症状(F=12.85, p<0.001)以及SF-12中的心理部分总分(F=16.13, p<0.001)均得到显著改善。然而,自我报告未受控制的糖尿病或高血压的率没有显著变化。
　　结论：这些结果支持了以社区为基础的干预措施的可行性,以降低在精神科人力资源有限的中低等收入国家中慢性疾病患者抑郁和焦虑症状的严重程度。然而,在确认该措施广泛大规模实施前还有大量方法学上的挑战需在未来研究中解决。     

Mental Health Disorders of the Indonesian People in the Early Stages of the COVID-19 Pandemic: Who is Vulnerable to Experiencing it?

The extraordinary situation related to COVID-19 makes people worry about their health, family health, work, finances, and other daily activities. This condition can lead to social unrest, which has consequences for mental health problems. This study aims to determine the mental health consequences at the beginning of the COVID-19 pandemic in Indonesia. This is a cross-sectional study involving a target population aged 18 years and over who had access to electronic communication devices. An online questionnaire was randomly distributed and snowballed throughout 34 provinces in Indonesia. The study was conducted from 2 to 4 May 2020. Non-parametric and multivariate linear regression analyses were performed to identify factors associated with anxiety and depression. Two thousand seven hundred forty-three participants were involved in this study, with 69.16% female. In sum, 6.92% of participants had General Anxiety Disorder-7 (GAD-7) scores ≥ 10 for moderate-severe anxiety symptoms, and 8.57% had Patient Health Questionnaire-9 (PHQ-9) scores ≥ 10 for moderate-severe depressive symptoms. The multivariate linear regression analyses showed that the strongest factors influencing anxiety and depression were a history of mental illnesses, chronic illnesses, the group affected by layoffs or job seekers, unemployed, students, younger age group, living in a rented house, single, and female. In contrast, the lower and secondary education level seems to reduce the risk of depression compared to those with higher education levels. Anxiety and depression occur during the periods of activity restriction during the COVID-19 pandemic and are influenced by several modifiable and non-modifiable factors. There is an urgent need to emphasize vulnerable groups such as those with a history of illness, those affected by layoffs/looking for work, and the younger age group.     

Mental health and the effects on methylation of stress-related genes in front-line versus other health care professionals during the second wave of COVID-19 pandemic: an Italian pilot study

Healthcare workers experienced high degree of stress during COVID-19. Purpose of the present article is to compare mental health (depressive and Post-Traumatic-Stress-Disorders—PTSD—symptoms) and epigenetics aspects (degree of methylation of stress-related genes) in front-line healthcare professionals versus healthcare working in non-COVID-19 wards. Sixty-eight healthcare workers were included in the study: 39 were working in COVID-19 wards (cases) and 29 in non-COVID wards (controls). From all participants, demographic and clinical information were collected by an ad-hoc questionnaire. Depressive and PTSD symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9) and the Impact of Event Scale—Revised (IES-R), respectively. Methylation analyses of 9 promoter/regulatory regions of genes known to be implicated in depression/PTSD (ADCYAP1, BDNF, CRHR1, DRD2, IGF2, LSD1/KDM1A, NR3C1, OXTR, SLC6A4) were performed on DNA from blood samples by the MassARRAY EpiTYPER platform, with MassCleave settings. Controls showed more frequent lifetime history of anxiety/depression with respect to cases (χ² = 5.72, p = 0.03). On the contrary, cases versus controls presented higher PHQ-9 (t = 2.13, p = 0.04), PHQ-9 sleep item (t = 2.26, p = 0.03), IES-R total (t = 2.17, p = 0.03), IES-R intrusion (t = 2.46, p = 0.02), IES-R avoidance (t = 1.99, p = 0.05) mean total scores. Methylation levels at CRHR1, DRD2 and LSD1 genes was significantly higher in cases with respect to controls (p < 0.01, p = 0.03 and p = 0.03, respectively). Frontline health professionals experienced more negative effects on mental health during COVID-19 pandemic than non-frontline healthcare workers. Methylation levels were increased in genes regulating HPA axis (CRHR1) and dopamine neurotransmission (DRD2 and LSD1), thus supporting the involvement of these biological processes in depression/PTSD and indicating that methylation of these genes can be modulated by stress conditions, such as working as healthcare front-line during COVID-19 pandemic.

     

Exercise,Depression, and Anxiety in Young People: A Cross-Sectional Survey

Background: Depression and anxiety are highly prevalent among adolescents and have multiple negative effects on their physical and mental health. While exercise can reduce the symptoms of depression and anxiety, the relationship between mental disorders among American university students has been rarely reported. Accordingly, this study aimed to explore the association between exercise, depression and anxiety among American university students in the 2018–2019 academic year. Methods: In this cross-sectional study, the association between exercise, depression and anxiety was investigated in a large representative sample of American university students. In the 2018–2019 academic year, university students aged 18+ years old from 79 institutions participated in this school-based study. The questionnaire included measurements of demographic characteristics, exercise, and validated screen instructions for depression (PHQ-9) and anxiety (GAD-7). The multivariable logistic regression model was applied to explore the association between exercise, depression and anxiety. Results: A total of 62026 individuals (31.9% males) participated in this survey, and the prevalence of exercising at least 5 h each day was 24.6%. The prevalence of depression and anxiety was 25.7% and 22.3%, respectively. In the multivariable logistic regression model, compared to exercise at least 5 h daily, participants whose exercise less than 1 h daily (OR = 1.31 [1.29, 1.33], p < 0.05), 2 to 3 h daily (OR = 1.13 [1.11, 1.15], p < 0.05), 3 to 4 h daily (OR = 1.04 [1.02, 1.06], p < 0.05), were correlated with greater odds of depression, while exercise less than 1 h daily (OR = 1.23 [1.21, 1.25], p < 0.05), 2 to 3 h daily (OR = 1.10 [1.08, 1.12], p < 0.05) were significantly correlated with greater odds of anxiety. Conclusion: Higher levels of exercise are associated with lower risk of depression and anxiety among American university students. Community and school interventions should focus on increasing exercise participation in university populations to promote both physical and mental health.     

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

ObjectiveWe aimed to investigate the effect of nursing professionals’ resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. MethodsWe conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. ResultsResilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31–1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03–1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85–0.97) were expecting variables for the depression of healthcare workers. ConclusionNursing professionals’ level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.     

Onset aging conditions of adults with an intellectual disability associated with primary caregiver depression

Caregivers of adults with an intellectual disability experience depressive symptoms, but the aging factors of the care recipients associated with the depressive symptoms are unknown. The objective of this study was to analyze the onset aging conditions of adults with an intellectual disability that associated with the depression scores of their primary caregivers. A cross-sectional survey was administered to gather information from 455 caregivers of adults with an intellectual disability about their symptoms of depression which assessed by a 9-item Patient Health Questionnaire (PHQ-9). The 12 aging conditions of adults with an intellectual disability include physical and mental health. The results indicate that 78% of adults with an intellectual disability demonstrate aging conditions. Physical conditions associated with aging include hearing decline (66.3%), vision decline (63.6%), incontinence (44%), articulation and bone degeneration (57.9%), teeth loss (80.4), physical strength decline (81.2%), sense of taste and smell decline (52.8%), and accompanied chronic illnesses (74.6%). Mental conditions associated with aging include memory loss (77%), language ability deterioration (74.4%), poor sleep quality (74.2%), and easy onset of depression and sadness (50.3%). Aging conditions of adults with an intellectual disability (p < 0.001) was one factor that significantly affected the presence of depressive symptom among caregivers after controlling demographic characteristics. Particularly, poor sleep quality of adults with an intellectual disability (yes vs. no, OR = 3.807, p = 0.002) was statistically correlated to the occurrence of significant depressive symptoms among their caregivers. This study suggests that the authorities should reorient community services and future policies toward the needs of family caregivers to decrease the burdens associated with caregiving.     

The short- and long-term effect of duloxetine on painful physical symptoms in patients with generalized anxiety disorder: Results from three clinical trials

Generalized anxiety disorder (GAD) is associated with painful physical symptoms (PPS). These post hoc analyses of previous trial data assessed PPS and their response to duloxetine treatment in GAD patients. Studies 1 and 2 (n = 840) were 9- to 10-week efficacy trials; study 3 (n = 887) was a relapse prevention trial comprising a 26-week open-label treatment phase and a 26-week double-blind, placebo-controlled treatment continuation phase. Mean baseline visual analog scale scores (VAS, 0–100; n = 1727) ranged from 26 to 37 for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time in pain while awake. In studies 1 and 2, improvement on all VAS scores was greater in duloxetine-treated than in placebo-treated patients (p ≤ 0.01). In study 3, pain symptoms worsened in responders switched to placebo compared with those maintained on duloxetine (p ≤ 0.02). In conclusion, duloxetine was efficacious in the short- and long-term treatment of PPS, which are common in GAD patients.     

Psychometric Evidence of the 7-Item Generalized Anxiety Disorder Questionnaire in Brazil

Generalized anxiety disorder (GAD) is one of the most prevalent and impairing psychological disorders. GAD is defined as a persistent and excessive worry associated with physical and psychological symptoms. Despite the potentially severe nature of GAD, it has been estimated that nearly half of patients live with the symptoms for about 2 years before being appropriately diagnosed and treated. To allow early identification of this disorder, valid and reliable measures for the screening of GAD are essential. Therefore, the present study aimed to gather psychometric evidence of the 7-Item Generalized Anxiety Disorder Questionnaire (GAD-7) in Brazil (N =?746). The findings suggested a stable one-factor structure (CFI?=?.99; TLI?=?.99; RMSEA?=?.05) that is likely to be replicated (H-Latent?=?.92; H-Observed?=?.86) and have excellent reliability (ω?=?.91; CR?=?.91). Furthermore, the GAD-7 correlated positively with the DASS-21 stress (r =?.73), depression (r =?.53), and anxiety (r =?.60) factors, along with the Groningen Sleep Quality Scale (r =?.45) and the personality trait of neuroticism (r =?.49), supporting its convergent validity. Finally, the GAD-7 is able to differentiate between participants with mild, moderate, and severe level of anxiety. Taken together, the present findings indicate that the GAD-7 is a suitable psychometric measure to assess generalized anxiety disorder in Brazil.

     

The Ability of the Symptom Checklist SCL-90 to Differentiate Various Anxiety and Depressive Disorders

We studied the use of the Symptom Checklist-90 (SCL-90) to differentiate between specific anxiety and depressive disorders and/or their symptoms in 280 patients with 6 DSM-III-R diagnoses: major depression (MD), panic disorder (PD), generalized anxiety disorder (GAD), social phobia (SP), obsessive-compulsive disorder (OCD), and mixed anxiety and depression (MAD). Using a comparison group, we found specific patterns for some of the diagnostic categories. Both the MD and MAD subjects had significantly high paranoid ideation, interpersonal sensitivity, hostility, and psychoticism, as well as high depression subscale scores; those with PD and GAD has the highest anxiety and somatization scores; and those with SP or OCD had a mixed pattern. When ranking the severity of psychopathology, the disorders ordered from most to least were MAD, MD, PD, GAD, SP, and OCD. Subsyndromal levels of symptoms frequently were associated with the various conditions. Use of the SCL-90 subscale helps to enlarge our understanding of the various anxiety and depressive disorders.     

Family caregivers’ sleep disturbance and its associations with multilevel stressors when caring for patients with dementia

Objective: We tested a stress process model of multilevel stressors on sleep disturbance for family caregivers (FCG) of persons with dementia (PWD).Methods: For this cross-sectional study, trained research assistants collected data from a purposive sample of 180 PWD–FCG dyads at two teaching hospitals, two local hospitals, and two community long-term care service programs in northern Taiwan. PWDs’ neuropsychiatric symptoms were assessed using the Chinese Neuropsychiatric Inventory (CNPI), FCGs’ distress by CNPI Caregiver Distress Scale, physical fatigue by Visual Analogue for Fatigue Scale, mental fatigue by Attentional Function Index, depressive symptoms by the Center for Epidemiological Studies Depression Scale – Short Form, and sleep disturbance by the General Sleep Disturbance Scale.Results: FCGs’ most prevalent sleep disturbance problems were sleep quality problems (99.4%). Hierarchical regression models revealed that FCGs’ sleep disturbance was predicted by their physical fatigue, their depressive symptoms, and the synergistic effect of physical fatigue and depressive symptoms in the final model, explaining 57.8% of the variance.Conclusions: This study supports the model that development of caregivers’ sleep problems may depend on their depression, fatigue, and the synergistic effects of these two variables. These findings suggest that clinicians should educate FCGs about self-care and offer strategies for dealing with a cluster of symptoms when maintaining sleep hygiene.     

Emotional logic development profiles – validating the benefits and safety of emotional logic training

Objective: Validation of the Emotional Logic Development Profile (ELDP) as a measure of improvements in emotional literacy and well-being resulting from emotional logic (EL) training; a programme designed to improve emotional literacy and reduce depression and anxiety.

Method: A general adult population sample was recruited to obtain normative ELDP data, from which clinically significant change, reliability and psychometric properties could be assessed against a patient sample. This consisted of 53 patients at a UK primary care medical practice who were offered EL while on a waiting list for other psychological therapies. Patients completed the PHQ-9, GAD-7 and ELDP at initial and two-month follow-up sessions. ELDP factor structure and sensitivity were assessed, and semistructured follow-up interviews provided additional qualitative data on acceptability.

Results: PHQ-9, GAD-7 and ELDP all showed significant improvements between pre- and post-EL measurement. The ELDP appears unidimensional, provides additional information to the PHQ-9 and GAD-7 and is sensitive to change. Furthermore, 17% of patients showed reliable, clinically significant improvements in ELDP scores. General practice (GP) consultations and medication use both significantly reduced.

Conclusions: The ELDP reliably measures ELs impact on reducing depression and anxiety. Further evaluation of EL viability for wider use in primary care, and in other age groups, may prove beneficial.     

伴与不伴广泛性焦虑障碍女性单相抑郁症患者的研究

目的:探讨伴与不伴广泛性焦虑障碍(GAD)中国汉族女性单相抑郁症患者的临床特点、发病次数和影响因素等方面的差异。方法:由受过CONVERGE团队至少1周访谈培训的访谈员,用电脑评估系统对1970例年龄30～60岁女性单相抑郁患者进行访谈,访谈内容包括精神病理学、人口学、个性特点和心理社会功能评估等;有关精神病理学诊断的量表采用综合国际诊断访谈(CIDI,WHO版本2.1,中国版)和美国精神障碍诊断与统计手册第3版(DSM-III修订本),其他量表则采用CONVERGE团队翻译和修正的源于VATSPSUD的工具。结果:单相抑郁伴发GAD的比率较高(68%);伴发GAD的抑郁症患者初次发病年龄较小,且发病次数多,病情重,更多地伴有生物学症状以及神经质的比率较高(P<0.001);但发病次数≥10次,则发病的年龄与次数无明显差异(P>0.05)。伴与不伴GAD在亲情关系方面则与父亲的温情及母亲的保护有关(P=0.007,0.035);而与受教育程度、职业类别无关(P>0.05)。结论:女性单相抑郁症与GAD有较高的相关度。     

Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population

Objective

Depression is one of the most common mental illnesses. The reliability and the validity of the Patient Health Questionnaire (PHQ)-9, a depression screening tool, have not been examined in the general population in China. Thus, this study evaluated the reliability and the validity of the Chinese version of the PHQ-9 in detecting major depression in residents of a Chinese community.

Methods

A total of 1045 participants from a Shanghai community were enrolled in our study. Participants completed the Chinese versions of the PHQ-9, the Self-Rating Depression Scale (SDS), the 36-item Short Form Health Survey (SF-36), and the Mini International Neuropsychiatric Interview. One hundred participants were randomly selected to complete the PHQ-9 again 2 weeks after the initial assessment. The reliability, the validity and the receiver operating characteristic (ROC) curve of the PHQ-9 were analyzed.

Results

Cronbach's alpha for the internal consistency reliability of the Chinese version of the PHQ-9 was 0.86 for the entire scale. The correlation coefficient for the 2-week test–retest of the total score was 0.86. The PHQ-9 scale correlated positively with the SDS (r=0.29, p<0.001) and correlated negatively with all subscale scores of the SF-36 (correlation coefficients ranged from − 0.11 to − 0.47, p<0.001). The area under the curve of the ROC was 0.92 (95% confidence interval: 0.86–0.97). A cutoff score of 7 or higher on the PHQ-9 had a sensitivity of 0.86 and a specificity of 0.86.

Conclusions

In the general Chinese population, the Chinese version of the PHQ-9 is a valid and efficient tool for screening depression, with a recommended cutoff score of 7 or more.