What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular diseases (n=3500). Intervention: PHQ-2 and GAD-2 vs. PHQ-9 and GAD-7. Primary outcome: Psychometric properties (sensitivity and specificity) of PHQ-2 and GAD-2 compared to PHQ-9 and GAD-7.

October 7, 2020

Examination of the best cut-off points of PHQ-2 and GAD-2 for detecting depression and anxiety in Italian cardiovascular inpatients

Key Result

The PHQ-2 threshold of ≥2 and the GAD-2 threshold of ≥3 provided the best balance of sensitivity and specificity for detecting depression and anxiety in Italian cardiovascular inpatients.

Study Design

Type

Cross-Sectional (n=3,500)

Structured PICO

What are the optimal cut-off points for the PHQ-2 and GAD-2 questionnaires to screen for depression and anxiety in cardiovascular inpatients?

Population

3,500 Italian cardiovascular inpatients evaluated to determine the optimal cut-off points for the PHQ-2 and GAD-2 screening questionnaires.

Exposure

2-item Patient Health Questionnaire (PHQ-2) and 2-item Generalized Anxiety Disorder (GAD-2) screening tools

Comparator

9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) as reference standards

Outcome

Psychometric properties (sensitivity, specificity, false positive and false negative rates) to determine optimal cut-off pointspatient reported

The PHQ-2 (cut-off ≥ 2) and GAD-2 (cut-off ≥ 3) are valid, brief screening tools for depression and anxiety in cardiovascular inpatients.

Abstract

OBJECTIVE: Despite the frequent association between anxiety, depression and cardiovascular diseases (CVD), cardiovascular inpatients are not usually screened for these psychopathological conditions. To fill this gap, especially in hospital environments, there is the need of brief screening instruments that provide reliable information in a very short time. According to this need, the aim of this study was to examine the best cut-off points of two brief and easy-to-use questionnaires in a sample of Italian cardiovascular inpatients: the 2-item Patient Health Questionnaire (PHQ-2) and the 2-item Generalized Anxiety Disorder (GAD-2). DESIGN: 3500 cardiovascular inpatients were recruited and completed both the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7). PHQ-2 and GAD-2 were then obtained extracting the first two item from PHQ-9 and GAD-7. MAIN OUTCOME MEASURES: The PHQ-2 and GAD-2 psychometric properties were calculated comparing them with PHQ-9 and GAD-7, respectively. RESULTS: The PHQ-2 threshold of ≥ 2 and the GAD-2 threshold of ≥ 3 are the best solutions in balancing between sensitivity and specificity, also providing acceptable rates of false positives and false negatives. CONCLUSIONS: the PHQ-2 and GAD-2 Italian versions showed good diagnostic features for measuring depression and anxiety in CVD patients.

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