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Reliability and validity of the Thai version of the PHQ-9.
BMC Psychiatry 2008; 8:46BP

Abstract

BACKGROUND

Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.

METHODS

The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed.

RESULTS

Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 >/= 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92).

CONCLUSION

The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.

Authors+Show Affiliations

Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. ramlt@mahidol.ac.thNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18570645

Citation

Lotrakul, Manote, et al. "Reliability and Validity of the Thai Version of the PHQ-9." BMC Psychiatry, vol. 8, 2008, p. 46.
Lotrakul M, Sumrithe S, Saipanish R. Reliability and validity of the Thai version of the PHQ-9. BMC Psychiatry. 2008;8:46.
Lotrakul, M., Sumrithe, S., & Saipanish, R. (2008). Reliability and validity of the Thai version of the PHQ-9. BMC Psychiatry, 8, p. 46. doi:10.1186/1471-244X-8-46.
Lotrakul M, Sumrithe S, Saipanish R. Reliability and Validity of the Thai Version of the PHQ-9. BMC Psychiatry. 2008 Jun 20;8:46. PubMed PMID: 18570645.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reliability and validity of the Thai version of the PHQ-9. AU - Lotrakul,Manote, AU - Sumrithe,Sutida, AU - Saipanish,Ratana, Y1 - 2008/06/20/ PY - 2007/09/20/received PY - 2008/06/20/accepted PY - 2008/6/24/pubmed PY - 2008/8/30/medline PY - 2008/6/24/entrez SP - 46 EP - 46 JF - BMC psychiatry JO - BMC Psychiatry VL - 8 N2 - BACKGROUND: Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients. METHODS: The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed. RESULTS: Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 >/= 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92). CONCLUSION: The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater. SN - 1471-244X UR - https://www.unboundmedicine.com/medline/citation/18570645/Reliability_and_validity_of_the_Thai_version_of_the_PHQ_9_ L2 - https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-8-46 DB - PRIME DP - Unbound Medicine ER -