Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2022; 11(5): 341-351
Published online Sep 25, 2022. doi: 10.5501/wjv.v11.i5.341
Validity of the patient health questionnaires (phq-2 and phq-9) for screening depression among human immunodeficiency virus patients in Lahore, Pakistan
Khunsa Junaid, Iqra Akram, Muhammad Daood, Amjad Khan
Khunsa Junaid, Muhammad Daood, Department of Community Medicine, King Edward Medical University, Lahore 54000, Punjab Province, Pakistan
Iqra Akram, Department of Pulmonology, General Hospital, Lahore 54000, Punjab Province, Pakistan
Amjad Khan, Department of Public Health and Nutrition, the University of Haripur, Haripur 22781, Khyber Pakhtunkhwa, Pakistan
Author contributions: All authors contributed to the concept of this study; Junaid K, Akram I conceived the study; Daood M carried out the literature searches; Junaid K distributed the questionnaires and extracted the data; Daood M assessed the study quality; Junaid K and Khan A performed the statistical analysis; Junaid K and Daood M wrote the manuscript; Khan A revised the manuscript; all the authors read the published version of the manuscript and gave their consent.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Jinnah hospital Lahore, Pakistan.
Informed consent statement: Informed consent was obtained from all patients for being included in the study.
Conflict-of-interest statement: All the authors have no conflicts of interest.
Data sharing statement: Participants gave informed consent for data sharing and the presented data are anonymized and the risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Khunsa Junaid, Post-graduate trainee, Department of Community Medicine, King Edward Medical University, Lahore 54000, Punjab Province, Pakistan. khunsajunaidmir@gmail.com
Received: March 20, 2022
Peer-review started: March 20, 2022
First decision: April 18, 2022
Revised: May 6, 2022
Accepted: August 26, 2022
Article in press: August 26, 2022
Published online: September 25, 2022
Processing time: 187 Days and 21.2 Hours
ARTICLE HIGHLIGHTS
Research background

People living with human immunodeficiency virus (HIV) infection (PLWHA) seem to be more vulnerable to psychiatric morbidity than the overall population, with major depressive disorder seems to be the most prevalent psychiatric diagnosis. Suicidal thinking, anxiety, post-traumatic stress disorder, and drug/alcohol use disorders are also frequently documented psychiatric morbidities in HIV patients

Research motivation

Many HIV-infected patients suffer from depression, but a little focus is given to detecting and treating depression in primary health care. Detection of depression can be improved by introducing short, reliable, and valid screening instruments.

Research objectives

The current study assessed the psychometric properties of the patient health questionnaire-2 (PHQ-2) and patient health questionnaire-9 (PHQ-9) for depression screening and diagnosis and estimated the sensitivity and specificity of the PHQ-2 for depression screening in HIV-infected patients.

Research methods

A cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore, Pakistan. PHQ-2 was implemented to screen depression. PHQ-9 was implemented to diagnose major depressive disorder as a reference standard. Reliability, Validity tests and receiver operating characteristic curve were computed.

Research conclusions

Due to the substantial health and social liability of depression and need for brief, organized, reliable, and valid tools that can help medical practitioners better assess patients for depression, the PHQ-2 and PHQ-9 would indeed be useful and beneficial instruments for screening and diagnosing depression in HIV-infected persons. Moreover, to lessen the global prevalence of psychiatric disorders and improve patient well-being, the instruments can be used in combination with increased access to adequate mental healthcare and therapeutical and non-pharmacological treatments, which are effective in these settings

Research results

The Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759, respectively. The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924, with both sensitivity and specificity of 0.96, and the area under the curve for PHQ-2 was 0.98 (95%CI: 0.953-0.998).

Research perspectives

HIV patients are more likely than the general population to develop depression. The PHQ-2 and PHQ-9 demonstrated good psychometric properties, implying that they might be helpful as depression screening tools.