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

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

Miyabi Ishihara, Daphna Harel, Brooke Levis, Alexander W. Levis, Kira E. Riehm, Nazanin Saadat, Marleine Azar, Danielle B. Rice, Tatiana A. Sanchez, Matthew J. Chiovitti, Pim Cuijpers, Simon Gilbody, John P.A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Bruce Arroll, Charles H. Bombardier, Peter Butterworth & 21 others Gregory Carter, Kerrie Clover, Yeates Conwell, Felicity Goodyear-Smith, Catherine G. Greeno, John Hambridge, Patricia A. Harrison, Marie Hudson, Nathalie Jetté, Kim M. Kiely, Anthony McGuire, Brian W. Pence, Alasdair G. Rooney, Abbey Sidebottom, Adam Simning, Alyna Turner, Jennifer White, Mary A. Whooley, Kirsty Winkley, Andrea Benedetti, Brett D. Thombs

Research output: Contribution to journalArticle

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 languageEnglish (US)
JournalDepression and Anxiety
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Self Report
Mental Health
Depression
Health
Sensitivity and Specificity
Routine Diagnostic Tests
Reproducibility of Results
Statistical Factor Analysis
Surveys and Questionnaires
Research
Population

Keywords

  • depression
  • Patient Health Questionnaire
  • patient outcome assessment
  • psychometrics

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Shortening self-report mental health symptom measures through optimal test assembly methods : Development and validation of the Patient Health Questionnaire-Depression-4. / Ishihara, Miyabi; Harel, Daphna; Levis, Brooke; Levis, Alexander W.; Riehm, Kira E.; Saadat, Nazanin; Azar, Marleine; Rice, Danielle B.; Sanchez, Tatiana A.; Chiovitti, Matthew J.; Cuijpers, Pim; Gilbody, Simon; Ioannidis, John P.A.; Kloda, Lorie A.; McMillan, Dean; Patten, Scott B.; Shrier, Ian; Arroll, Bruce; Bombardier, Charles H.; Butterworth, Peter; Carter, Gregory; Clover, Kerrie; Conwell, Yeates; Goodyear-Smith, Felicity; Greeno, Catherine G.; Hambridge, John; Harrison, Patricia A.; Hudson, Marie; Jetté, Nathalie; Kiely, Kim M.; McGuire, Anthony; Pence, Brian W.; Rooney, Alasdair G.; Sidebottom, Abbey; Simning, Adam; Turner, Alyna; White, Jennifer; Whooley, Mary A.; Winkley, Kirsty; Benedetti, Andrea; Thombs, Brett D.

In: Depression and Anxiety, 01.01.2018.

Research output: Contribution to journalArticle

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 2018, '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. https://doi.org/10.1002/da.22841
Ishihara, Miyabi ; Harel, Daphna ; Levis, Brooke ; Levis, Alexander W. ; Riehm, Kira E. ; Saadat, Nazanin ; Azar, Marleine ; Rice, Danielle B. ; Sanchez, Tatiana A. ; Chiovitti, Matthew J. ; Cuijpers, Pim ; Gilbody, Simon ; Ioannidis, John P.A. ; Kloda, Lorie A. ; McMillan, Dean ; Patten, Scott B. ; Shrier, Ian ; Arroll, Bruce ; Bombardier, Charles H. ; Butterworth, Peter ; Carter, Gregory ; Clover, Kerrie ; Conwell, Yeates ; Goodyear-Smith, Felicity ; Greeno, Catherine G. ; Hambridge, John ; Harrison, Patricia A. ; Hudson, Marie ; Jetté, Nathalie ; Kiely, Kim M. ; McGuire, Anthony ; Pence, Brian W. ; Rooney, Alasdair G. ; Sidebottom, Abbey ; Simning, Adam ; Turner, Alyna ; White, Jennifer ; Whooley, Mary A. ; Winkley, Kirsty ; Benedetti, Andrea ; Thombs, Brett D. / Shortening self-report mental health symptom measures through optimal test assembly methods : Development and validation of the Patient Health Questionnaire-Depression-4. In: Depression and Anxiety. 2018.
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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 = "Miyabi Ishihara and Daphna Harel and Brooke Levis and Levis, {Alexander W.} and Riehm, {Kira E.} and Nazanin Saadat and Marleine Azar and Rice, {Danielle B.} and Sanchez, {Tatiana A.} and Chiovitti, {Matthew J.} and Pim Cuijpers and Simon Gilbody and Ioannidis, {John P.A.} and Kloda, {Lorie A.} and Dean McMillan and Patten, {Scott B.} and Ian Shrier and Bruce Arroll and Bombardier, {Charles H.} and Peter Butterworth and Gregory Carter and Kerrie Clover and Yeates Conwell and Felicity Goodyear-Smith and Greeno, {Catherine G.} and John Hambridge and Harrison, {Patricia A.} and Marie Hudson and Nathalie Jett{\'e} and Kiely, {Kim M.} and Anthony McGuire and Pence, {Brian W.} and Rooney, {Alasdair G.} and Abbey Sidebottom and Adam Simning and Alyna Turner and Jennifer White and Whooley, {Mary A.} and Kirsty Winkley and Andrea Benedetti and Thombs, {Brett D.}",
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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, Miyabi

AU - Harel, Daphna

AU - Levis, Brooke

AU - Levis, Alexander W.

AU - Riehm, Kira E.

AU - Saadat, Nazanin

AU - Azar, Marleine

AU - Rice, Danielle B.

AU - Sanchez, Tatiana A.

AU - Chiovitti, Matthew J.

AU - Cuijpers, Pim

AU - Gilbody, Simon

AU - Ioannidis, John P.A.

AU - Kloda, Lorie A.

AU - McMillan, Dean

AU - Patten, Scott B.

AU - Shrier, Ian

AU - Arroll, Bruce

AU - Bombardier, Charles H.

AU - Butterworth, Peter

AU - Carter, Gregory

AU - Clover, Kerrie

AU - Conwell, Yeates

AU - Goodyear-Smith, Felicity

AU - Greeno, Catherine G.

AU - Hambridge, John

AU - Harrison, Patricia A.

AU - Hudson, Marie

AU - Jetté, Nathalie

AU - Kiely, Kim M.

AU - McGuire, Anthony

AU - Pence, Brian W.

AU - Rooney, Alasdair G.

AU - Sidebottom, Abbey

AU - Simning, Adam

AU - Turner, Alyna

AU - White, Jennifer

AU - Whooley, Mary A.

AU - Winkley, Kirsty

AU - Benedetti, Andrea

AU - Thombs, Brett D.

PY - 2018/1/1

Y1 - 2018/1/1

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.

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KW - Patient Health Questionnaire

KW - patient outcome assessment

KW - psychometrics

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DO - 10.1002/da.22841

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