Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study

Objective To evaluate the clinical reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis.Design Cross-sectional study.Setting Tertiary care centre.Participants Patients with psoriasis who have not been diagnosed with depression (n=...

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Main Authors: Changqiang Li, Xue-Li Zhang, Xin Ye, Hui-Ling Shu, Xia Feng, Deng-mei Xia, Zheng-qun Wang, Wen-yao Mi, Bei Yu
Format: Article
Language:English
Published: BMJ Publishing Group 2020-07-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/10/7/e033211.full
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author Changqiang Li
Xue-Li Zhang
Xin Ye
Hui-Ling Shu
Xia Feng
Deng-mei Xia
Zheng-qun Wang
Wen-yao Mi
Bei Yu
author_facet Changqiang Li
Xue-Li Zhang
Xin Ye
Hui-Ling Shu
Xia Feng
Deng-mei Xia
Zheng-qun Wang
Wen-yao Mi
Bei Yu
author_sort Changqiang Li
collection DOAJ
description Objective To evaluate the clinical reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis.Design Cross-sectional study.Setting Tertiary care centre.Participants Patients with psoriasis who have not been diagnosed with depression (n=148; mean age 43.37±17.46 years; 31.19% female).Primary and secondary outcome measures The primary outcome measures considered in this study were the C-PHQ-9 and the Hamilton Depression Scale (HAMD). The American Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) was used as the gold standard for the diagnosis of depression. Cronbach’s α and test–retest reliability after 1 week were evaluated using reliability analysis, and criterion and structural validity were assessed using validity analysis. Receiver operating characteristic (ROC) analysis was performed to identify the best demarcation score and diagnostic accuracy.Results Compared with DSM-V (27.27%), both C-PHQ-9 (39.19%) and HAMD (31.01%) had higher rates for detecting depression. The mean completion time for C-PHQ-9 evaluation (2.02±0.84 min) was significantly less than that for HAMD (23.37±3.21 min, p<0.001). The Cronbach’s α coefficient for the C-PHQ-9 was 0.938. The correlation coefficients of the nine items with the total scale ranged from 0.540 to 0.854, and the mean inter-item correlation coefficients ranged from 0.376 to 0.933. After a week, the retest coefficient was 0.955 (p<0.01). Principal component factor analysis showed that C-PHQ-9 identified a unifactorial structure. The best cut-off point was 9 points, with a sensitivity of 98.00% and a specificity of 90.80%. The area under the ROC curve was 0.979 (95% CI 0.968 to 0.991).Conclusion C-PHQ-9 has good reliability and validity in patients with psoriasis and can be used for primary screening of patients with psoriasis and depression. This scale has obvious time and labour advantages over the HAMD and should be considered for use in clinical practice.
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spelling doaj-art-e583ab669c13451b9daefdc37466e0922025-08-20T02:18:43ZengBMJ Publishing GroupBMJ Open2044-60552020-07-0110710.1136/bmjopen-2019-033211Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional studyChangqiang Li0Xue-Li Zhang1Xin Ye2Hui-Ling Shu3Xia Feng4Deng-mei Xia5Zheng-qun Wang6Wen-yao Mi7Bei Yu8Department of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, China1 State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaInstitute for Global Public Policy, Fudan University, Shanghai, ChinaDepartment of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, China1 Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, ChinaDepartment of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, ChinaDepartment of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, ChinaDepartment of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, ChinaDepartment of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, ChinaObjective To evaluate the clinical reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis.Design Cross-sectional study.Setting Tertiary care centre.Participants Patients with psoriasis who have not been diagnosed with depression (n=148; mean age 43.37±17.46 years; 31.19% female).Primary and secondary outcome measures The primary outcome measures considered in this study were the C-PHQ-9 and the Hamilton Depression Scale (HAMD). The American Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) was used as the gold standard for the diagnosis of depression. Cronbach’s α and test–retest reliability after 1 week were evaluated using reliability analysis, and criterion and structural validity were assessed using validity analysis. Receiver operating characteristic (ROC) analysis was performed to identify the best demarcation score and diagnostic accuracy.Results Compared with DSM-V (27.27%), both C-PHQ-9 (39.19%) and HAMD (31.01%) had higher rates for detecting depression. The mean completion time for C-PHQ-9 evaluation (2.02±0.84 min) was significantly less than that for HAMD (23.37±3.21 min, p<0.001). The Cronbach’s α coefficient for the C-PHQ-9 was 0.938. The correlation coefficients of the nine items with the total scale ranged from 0.540 to 0.854, and the mean inter-item correlation coefficients ranged from 0.376 to 0.933. After a week, the retest coefficient was 0.955 (p<0.01). Principal component factor analysis showed that C-PHQ-9 identified a unifactorial structure. The best cut-off point was 9 points, with a sensitivity of 98.00% and a specificity of 90.80%. The area under the ROC curve was 0.979 (95% CI 0.968 to 0.991).Conclusion C-PHQ-9 has good reliability and validity in patients with psoriasis and can be used for primary screening of patients with psoriasis and depression. This scale has obvious time and labour advantages over the HAMD and should be considered for use in clinical practice.https://bmjopen.bmj.com/content/10/7/e033211.full
spellingShingle Changqiang Li
Xue-Li Zhang
Xin Ye
Hui-Ling Shu
Xia Feng
Deng-mei Xia
Zheng-qun Wang
Wen-yao Mi
Bei Yu
Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study
BMJ Open
title Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study
title_full Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study
title_fullStr Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study
title_full_unstemmed Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study
title_short Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study
title_sort reliability and validity of the chinese version of the patient health questionnaire 9 c phq 9 in patients with psoriasis a cross sectional study
url https://bmjopen.bmj.com/content/10/7/e033211.full
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