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. 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

Research output: Contribution to Journal › Article › Academic › peer-review

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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

This study was funded by the Canadian Institutes of Health Research (CIHR; KRS-134297). Dr. Harel was supported by NYU start-up research grants. Ms. Levis was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship doctoral award. Mr. Levis and Ms. Azar were supported by Fonds de recherche du Québec—Santé (FRQS) Masters Training Awards. Ms. Riehm and Ms. Saadat were supported by CIHR Frederick Banting and Charles Best Canadian Graduate Scholarships—Master's Awards. Ms. Rice was supported by a Vanier Canada Graduate Scholarship. The primary studies by Amoozegar and Fiest et al. were funded by the Alberta Health Services, University of Calgary Faculty of Medicine, and Hotchkiss Brain Institute. Collection of data for the study by Arroll et al. was supported by a project grant from the Health Research Council of New Zealand. Data for the study by Razykov et al. were collected by the Canadian Scleroderma Research Group, which was funded by the CIHR (FRN 83518), the Scleroderma Society of Canada, the Scleroderma Society of Ontario, the Scleroderma Society of Saskatchewan, Sclérodermie Québec, the Cure Scleroderma Foundation, Inova Diagnostics, Inc., Euroimmun, FRQS, the Canadian Arthritis Network, and the Lady Davis Institute of Medical Research of the Jewish General Hospital, Montreal, QC. The primary study by Bombardier et al. was supported by the Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington (grant no. H133N060033), Bay-lor College of Medicine (grant no. H133N060003), and University of Michigan (grant no. H133N060032). Collection of data for the primary study by Kiely et al. was supported by National Health and Medical Research Council (grant no. 1002160) and Safe Work Australia. Dr. Butterworth was supported by Australian Research Council Future Fellowship FT130101444. Dr. Conwell received support from NIMH (R24MH071604) and the Centers for Disease Control and Prevention (R49 CE002093). Collection of data for the primary study by Gjerdingen et al. was supported by grants from the NIMH (R34 MH072925, K02 MH65919, P30 DK50456). The primary study by Eack et al. was funded by the NIMH (R24 MH56858). Collection of data for the studies by Turner et al. was funded by a bequest from Jennie Thomas through the Hunter Medical Research Institute. The primary study by Sidebottom et al. was funded by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration (grant no. R40MC07840). Dr. Hudson was supported by an FRQS Senior Investigator Award. The primary study by Twist et al. was funded by the U.K. National Institute for Health Research under its Programme Grants for Applied Research Programme (grant reference no. RP-PG-0606-1142). Dr. Jetté was supported by a Canada Research Chair in Neurological Health Services Research. Dr. Kiely was supported by funding from Australian National Health and Medical Research Council fellowship (grant no. 1088313). Collection of data for the primary study by Williams et al. was supported by an NIMH grant to Dr. Marsh (RO1-MH069666). Collection of primary data for the study by Dr. Pence was provided by NIMH (R34MH084673). The primary study by Rooney et al. was funded by the U.K. National Health Service Lothian Neuro-Oncology Endowment Fund. Simning et al.’s research was supported in part by grants from the NIH (T32 GM07356), Agency for Healthcare Research and Quality (R36 HS018246), NIMH (R24 MH071604), and the National Center for Research Resources (TL1 RR024135). The primary study by Thombs et al. was done with data from the Heart and Soul Study (PI Mary Whooley). The Heart and Soul Study was funded by the Department of Veterans Epidemiology Merit Review Program, the Department of Veterans Affairs Health Services Research and Development service, the National Heart Lung and Blood Institute (R01 HL079235), the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Ischemia Research and Education Foundation. Drs. Benedetti and Thombs were supported by FRQS researcher salary awards. No other authors reported funding for primary studies or for their work on the present study. Safe Work Australia; Lady Davis Institute of Medical Research of the Jewish General Hospital; Inova Diagnostics Inc; Canadian Arthritis Network; Euroimmun; Alberta Health Services, the University of Calgary Faculty of Medicine, and the Hotchkiss Brain Institute; United States Department of Health and Human Services, Health Resources and Services Administration; Health Research Council of New Zealand; National Center for Research Resources; Australian National Health and Medical Research Council fellowship; United Kingdom National Health Service Lothian Neuro-Oncology Endowment Fund; National Institute of Mental Health, Grant/Award Numbers: K02 MH65919, P30 DK50456, R24 MH071604, R24 MH56858, R24MH071604, R34 MH072925, R34MH084673 Drs. Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funders	Funder number
Sclérodermie Québec
Robert Wood Johnson Foundation
Inova Diagnostics Inc
Canadian Arthritis Network
New York University
Vanier Canada Graduate Scholarship
Ischemia Research and Education Foundation
Fonds de Recherche du Québec - Santé
Lady Davis Institute of Medical Research of the Jewish General Hospital
National Institute on Disability and Rehabilitation Research
Scleroderma Society of Saskatchewan
Department of Veterans
National Institutes of Health
Hunter Medical Research Institute
Hotchkiss Brain Institute
Inova Diagnostics, Inc.
U.S. Department of Education
National Health Service Lothian Neuro-Oncology Endowment Fund
Euroimmun
U.S. Department of Health and Human Services
Alberta Health Services
American Federation for Aging Research
Institute
Cure Scleroderma Foundation
Pfizer
Scleroderma Society of Ontario
Scleroderma Society of Canada
Australian Research Council	FT130101444
National Health and Medical Research Council	1002160
National Institute of Mental Health	K02MH065919, R34MH072925, R24 MH56858, R01MH069666, R24MH071604, R34MH084673
National Heart, Lung, and Blood Institute	R01HL079235
Agency for Healthcare Research and Quality	R36 HS018246, R24 MH071604
Health Resources and Services Administration	R40MC07840
National Center for Research Resources	TL1RR024135
University of Michigan	H133N060032
Medical Research Council	MR/J000914/1
National Institute of Diabetes and Digestive and Kidney Diseases	P30DK050456
National Institute of General Medical Sciences	T32GM007356
Health Research Council of New Zealand	FRN 83518
University of Washington	H133N060033
Canadian Institutes of Health Research	KRS-134297
National Institute for Health Research	RO1-MH069666, RP-PG-0606-1142, 1088313
Bay-lor College of Medicine	H133N060003

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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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.",

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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 = "John Wiley and Sons Inc.",

number = "1",

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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

UR - https://www.scopus.com/pages/publications/85053533135

UR - https://www.scopus.com/pages/publications/85053533135#tab=citedBy

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

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Keywords

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