Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

M. Ishihara; D. Harel; B. Levis; A.W. Levis; K.E. Riehm; N. Saadat; M. Azar; D.B. Rice; T.A. Sanchez; M.J. Chiovitti; P. Cuijpers; S. Gilbody; J.P.A. Ioannidis; L.A. Kloda; D. McMillan; S.B. Patten; I. Shrier; B. Arroll; C.H. Bombardier; P. Butterworth; G. Carter; K. Clover; Y. Conwell; F. Goodyear-Smith; C.G. Greeno; J. Hambridge; P.A. Harrison; M. Hudson; N. Jetté; K.M. Kiely; A. McGuire; B.W. Pence; A.G. Rooney; A. Sidebottom; A. Simning; A. Turner; J. White; M.A. Whooley; K. Winkley; A. Benedetti; B.D. Thombs

doi:10.1002/da.22841

Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

M. Ishihara, D. Harel, B. Levis, A.W. Levis, K.E. Riehm, N. Saadat, M. Azar, D.B. Rice, T.A. Sanchez, M.J. Chiovitti, P. Cuijpers, S. Gilbody, J.P.A. Ioannidis, L.A. Kloda, D. McMillan, S.B. Patten, I. Shrier, B. Arroll, C.H. Bombardier, P. ButterworthG. Carter, K. Clover, Y. Conwell, F. Goodyear-Smith, C.G. Greeno, J. Hambridge, P.A. Harrison, M. Hudson, N. Jetté, K.M. Kiely, A. McGuire, B.W. Pence, A.G. Rooney, A. Sidebottom, A. Simning, A. Turner, J. White, M.A. Whooley, K. Winkley, A. Benedetti, B.D. Thombs

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Abstract

Background: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. Methods: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. Results: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). Conclusion: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.

Original language	English
Pages (from-to)	82-92
Number of pages	11
Journal	Depression and Anxiety
Volume	36
Issue number	1
Early online date	20 Sept 2018
DOIs	https://doi.org/10.1002/da.22841
Publication status	Published - Jan 2019

Bibliographical note

FOCUS ON: MEASURING AND DETECTING DEPRESSION

Funding

Funders	Funder number
Australian National Health and Medical Research Council
Bay-lor College of Medicine	H133N060003
Cure Scleroderma Foundation
Department of Education
Department of Veterans
Euroimmun
Inova Diagnostics Inc
Inova Diagnostics, Inc.
Institute
National Health Service Lothian Neuro-Oncology Endowment Fund
Scleroderma Society of Canada
Scleroderma Society of Saskatchewan
Sclérodermie Québec
Vanier Canada Graduate Scholarship
National Institutes of Health	T32 GM07356
U.S. Department of Health and Human Services
National Institute of Mental Health	K02 MH65919, R24 MH56858, R34 MH072925, R34MH084673
National Institute of Diabetes and Digestive and Kidney Diseases	P30DK050456
National Center for Research Resources	TL1 RR024135
Health Resources and Services Administration	R40MC07840
Agency for Healthcare Research and Quality	R36 HS018246, R24MH071604
Robert Wood Johnson Foundation
American Federation for Aging Research
Pfizer
National Institute on Disability and Rehabilitation Research
New York University
Ischemia Research and Education Foundation
University of Michigan	H133N060032
Alberta Health Services
University of Washington	H133N060033
Hotchkiss Brain Institute
Canadian Institutes of Health Research	KRS-134297
Fonds de Recherche du Québec - Santé
National Institute for Health Research	RO1-MH069666, RP-PG-0606-1142, 1088313
National Heart and Lung Institute	R01 HL079235
Australian Research Council	FT130101444
National Health and Medical Research Council	1002160
Hunter Medical Research Institute
Health Research Council of New Zealand	FRN 83518
Canadian Arthritis Network
Lady Davis Institute for Medical Research
Scleroderma Society of Ontario

Keywords

depression
Patient Health Questionnaire
patient outcome assessment
psychometrics

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10.1002/da.22841

Shortening selfreport mental health symptom measures through optimal test assembly methodsFinal published version, 447 KBLicence: Article 25fa Dutch Copyright Act

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Ishihara, M., Harel, D., Levis, B., Levis, A. W., Riehm, K. E., Saadat, N., Azar, M., Rice, D. B., Sanchez, T. A., Chiovitti, M. J., Cuijpers, P., Gilbody, S., Ioannidis, J. P. A., Kloda, L. A., McMillan, D., Patten, S. B., Shrier, I., Arroll, B., Bombardier, C. H., ... Thombs, B. D. (2019). Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4. Depression and Anxiety, 36(1), 82-92. https://doi.org/10.1002/da.22841

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title = "Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4",

abstract = "Background: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. Methods: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. Results: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). Conclusion: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.",

keywords = "depression, Patient Health Questionnaire, patient outcome assessment, psychometrics",

author = "M. Ishihara and D. Harel and B. Levis and A.W. Levis and K.E. Riehm and N. Saadat and M. Azar and D.B. Rice and T.A. Sanchez and M.J. Chiovitti and P. Cuijpers and S. Gilbody and J.P.A. Ioannidis and L.A. Kloda and D. McMillan and S.B. Patten and I. Shrier and B. Arroll and C.H. Bombardier and P. Butterworth and G. Carter and K. Clover and Y. Conwell and F. Goodyear-Smith and C.G. Greeno and J. Hambridge and P.A. Harrison and M. Hudson and N. Jett{\'e} and K.M. Kiely and A. McGuire and B.W. Pence and A.G. Rooney and A. Sidebottom and A. Simning and A. Turner and J. White and M.A. Whooley and K. Winkley and A. Benedetti and B.D. Thombs",

note = "FOCUS ON: MEASURING AND DETECTING DEPRESSION",

year = "2019",

month = jan,

doi = "10.1002/da.22841",

language = "English",

volume = "36",

pages = "82--92",

journal = "Depression and Anxiety",

issn = "1091-4269",

publisher = "Wiley-Blackwell",

number = "1",

}

Ishihara, M, Harel, D, Levis, B, Levis, AW, Riehm, KE, Saadat, N, Azar, M, Rice, DB, Sanchez, TA, Chiovitti, MJ, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, McMillan, D, Patten, SB, Shrier, I, Arroll, B, Bombardier, CH, Butterworth, P, Carter, G, Clover, K, Conwell, Y, Goodyear-Smith, F, Greeno, CG, Hambridge, J, Harrison, PA, Hudson, M, Jetté, N, Kiely, KM, McGuire, A, Pence, BW, Rooney, AG, Sidebottom, A, Simning, A, Turner, A, White, J, Whooley, MA, Winkley, K, Benedetti, A & Thombs, BD 2019, 'Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4', Depression and Anxiety, vol. 36, no. 1, pp. 82-92. https://doi.org/10.1002/da.22841

TY - JOUR

T1 - Shortening self-report mental health symptom measures through optimal test assembly methods

T2 - Development and validation of the Patient Health Questionnaire-Depression-4

AU - Ishihara, M.

AU - Harel, D.

AU - Levis, B.

AU - Levis, A.W.

AU - Riehm, K.E.

AU - Saadat, N.

AU - Azar, M.

AU - Rice, D.B.

AU - Sanchez, T.A.

AU - Chiovitti, M.J.

AU - Cuijpers, P.

AU - Gilbody, S.

AU - Ioannidis, J.P.A.

AU - Kloda, L.A.

AU - McMillan, D.

AU - Patten, S.B.

AU - Shrier, I.

AU - Arroll, B.

AU - Bombardier, C.H.

AU - Butterworth, P.

AU - Carter, G.

AU - Clover, K.

AU - Conwell, Y.

AU - Goodyear-Smith, F.

AU - Greeno, C.G.

AU - Hambridge, J.

AU - Harrison, P.A.

AU - Hudson, M.

AU - Jetté, N.

AU - Kiely, K.M.

AU - McGuire, A.

AU - Pence, B.W.

AU - Rooney, A.G.

AU - Sidebottom, A.

AU - Simning, A.

AU - Turner, A.

AU - White, J.

AU - Whooley, M.A.

AU - Winkley, K.

AU - Benedetti, A.

AU - Thombs, B.D.

N1 - FOCUS ON: MEASURING AND DETECTING DEPRESSION

PY - 2019/1

Y1 - 2019/1

N2 - Background: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. Methods: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. Results: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). Conclusion: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.

AB - Background: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. Methods: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. Results: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). Conclusion: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.

KW - depression

KW - Patient Health Questionnaire

KW - patient outcome assessment

KW - psychometrics

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U2 - 10.1002/da.22841

DO - 10.1002/da.22841

M3 - Article

SN - 1091-4269

VL - 36

SP - 82

EP - 92

JO - Depression and Anxiety

JF - Depression and Anxiety

IS - 1

ER -

Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

Abstract

Bibliographical note

Funding

Keywords

Access to Document

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