engleski

Screening performance of a short versus long version of the Patient Health Questionnaire-Depression in outpatients with diabetes

Background and aims: Regular screening for depressive symptoms in diabetic outpatients might improve both diabetes and depression outcomes. This study was aimed at comparing performance of a two-item vs a nine-item version of the Patient Health Questionnaire (PHQ-9) defined as a proportion of positively screened patients with confirmed elevated depressive symptoms by means of a clinical interview. Patients and methods: Two hundred sixty-three consecutively recruited diabetic patients attending their regular medical check-ups (90% with type 2 diabetes, aged 60± 11 yrs., with diabetes duration of 10± 8 yrs., 44% insulin-treated, with average HbA1C values of 7.4%± 1.4 and BMI of 29.7 kg/m2 ± 5.2) were screened for depression by using the PHQ-9 scale. Cut-off scores of 3 for the PHQ-2 and 10 for the PHQ-9 were used to discriminate between positive and negative screenings. Percentages of positive screenings on the two instrument's versions, and proportions of patients who were confirmed for elevated depressive symptoms by a clinical interview were compared. Results: Twenty-two percent of the patients assessed for depressive symptoms were found to be above the cut-offs indicative of depression. The percengates of positive screening did not differ by using the PHQ-2 and PHQ-9 indicators (22% vs 22% p= 0.88). Patients with elevated depressive symptoms did not differ from those scoring below the cut-offs with respect to age (60± 12 vs 60± 11 yrs. p=0.86), diabetes duration (10± 5 vs 10± 7 yrs. p=0.94), type of diabetes (χ 2 =0.60 p=0.44), insulin therapy (χ 2=0.55 p=0.46), HbA1C values (7.5%± 1.5 vs 7.3%± 1.4) and BMI (30.2 kg/m2± 5.4 vs 29.3 kg/m2± 4.4 p=0.21). There were more female patients in the subgroup indicative of depression (χ 2=11.6 p=0.0007). Thirty percent of patients positively screened by the PHQ-2 versus 37% of those positively screened by the PHQ-9 were confirmed for elevated depressive symptoms using a clinical interview (χ 2 =0.04 p=0.85). Conclusion: Finding elevated depressive symptoms in diabetic outpatients by using the PHQ-2 and PHQ-9 indicators was shown to be comparable with respect to both positive screenings per se and their proportion as confirmed by a more comprehensive diagnostic procedure. PHQ-2 could be recommended for routine use in diabetological check-ups in order to detect diabetic patients at a risk of depression.

depressive symptoms; screening for depression; diabetes mellitus

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