Key result
PHQ-9 accurately detects MDD in T2D using a lower optimal cut-off score of 7.
Why the study?
This study evaluated the psychometric characteristics and optimal cut-offs of the Polish version of the PHQ-9 for detecting major depression and dysthymia in people with versus without type 2 diabetes.
What is the optimal cut-off score for the PHQ-9 screening tool to detect depression in people with type 2 diabetes compared to those without?
Cross-Sectional (n=315)
Yes
What is the optimal cut-off score for the PHQ-9 screening tool to detect depression in people with type 2 diabetes compared to those without?
p-value: p=<0.001
People with type 2 diabetes require a lower PHQ-9 cut-off score (≥ 5-7) for depression screening compared to the general population (≥ 9-11).
Lower PHQ-9 threshold may aid depression detection in diabetes; leaves open prospective validation before changing practice.
AIMS: This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and 'MDD and/or dysthymia' in people with and without type 2 diabetes. METHODS: Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden's index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice. RESULTS: The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden's index and ≥ 5 by the two-stage method for screening for MDD and 'MDD and/or dysthymia' in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and 'MDD and/or dysthymia' among people without diabetes (Youden's index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for 'MDD and/or dysthymia' in people without diabetes. CONCLUSIONS: A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population.
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Cichoń et al. (2020) conducted a cross-sectional in Type 2 diabetes and depression (n=315). PHQ-9 (Polish version) vs. MINI (Mini International Neuropsychiatric Interview) was evaluated on Diagnostic accuracy (AUC) of PHQ-9 for major depressive disorder in patients with type 2 diabetes (95% CI 0.926-0.985, p=<0.001). The PHQ-9 demonstrated high diagnostic accuracy for major depressive disorder in patients with type 2 diabetes (AUC 0.956), with an optimal cut-off score of ≥7, which is lower than the ≥11 cut-off for people without diabetes.
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