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      Interformat reliability of the patient health questionnaire: Validation of the computerized version of the PHQ-9

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          Abstract

          Background

          Computerized versions of well-established measurements such as the PHQ-9 are widely used, but data on the comparability of psychometric properties are scarce.

          Objective

          Our objective was to compare the interformat reliability of the paper-and-pen version with a computerized version of the PHQ-9 in a clinical sample.

          Methods

          130 participants with mental health disorders were recruited during psychotherapeutic treatment in a mental health clinic. In a crossover design, they all completed the PHQ-9 in both the computerized and paper-and-pen versions in randomized order.

          Results

          The internal consistency was comparable for the computer (α = 0.88) and paper versions (α = 0.89), and highly significant correlations were found between the formats ( r = 0.92). PHQ-9 total scores were not significantly different between the paper and the computer delivered versions. There was a significant interaction effect between format and order of administration for the PHQ-9, indicating that the first administration delivered slightly higher scores.

          Limitations

          In order to reduce the required effort for the participants, we did not ask them to fill out anything but the PHQ-9 once in paper and once in computer version.

          Conclusions

          Our findings suggest that the PHQ-9 can be transferred to computerized use without affecting psychometric properties in a clinically meaningful way.

          Highlights

          • Evaluation of the interformat reliability of a widely used depression severity measure

          • Clinical sample

          • Crossover design

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          Most cited references22

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          Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness.

          Internet-based cognitive behavior therapy (ICBT) is a promising treatment that may increase availability of cognitive behavior therapy (CBT) for psychiatric disorders and other clinical problems. The main objective of this study was to determine the applications, clinical efficacy and cost-effectiveness of ICBT. The authors conducted a systematic review to identify randomized controlled trials investigating CBT delivered via the internet for adult patient populations. Searches to identify studies investigating cost-effectiveness of ICBT were also conducted. Evidence status for each clinical application was determined using the American Psychologist Association criteria for empirically supported treatments. Of 1104 studies reviewed, 108 met criteria for inclusion, of which 103 reported on clinical efficacy and eight on cost-effectiveness. Results showed that ICBT has been tested for 25 different clinical disorders, whereas most randomized controlled trials have been aimed at depression, anxiety disorders and chronic pain. Internet-based treatments for depression, social phobia and panic disorder were classified as well-established, that is, meeting the highest level of criteria for evidence. Effect sizes were large in the treatment of depression, anxiety disorders, severe health anxiety, irritable bowel syndrome, female sexual dysfunction, eating disorders, cannabis use and pathological gambling. For other clinical problems, effect sizes were small to moderate. Comparison to conventional CBT showed that ICBT produces equivalent effects. Cost-effectiveness data were relatively scarce but suggested that ICBT has more than 50% probability of being cost effective compared with no treatment or to conventional CBT when willingness to pay for an additional improvement is zero. Although ICBT is a promising treatment option for several disorders, it can only be regarded as a well-established treatment for depression, panic disorder and social phobia. It seems that ICBT is as effective as conventional CBT for respective clinical disorder, that is, if conventional CBT works then ICBT works. The large effects and the limited therapist time required suggest that the treatment is highly cost effective for well-established indications.
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            Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care.

            The 2004 National Institute for Health and Clinical Excellence (NICE) guidelines highlight the importance of assessing severity of depression in primary care. To assess the psychometric properties of the Patient Health Questionnaire (PHQ-9) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) for measuring depression severity in primary care. Psychometric assessment. Thirty-two general practices in Grampian, Scotland. Consecutive patients referred to a primary care mental health worker completed the PHQ-9 and HADS at baseline (n = 1063) and at the end of treatment (n = 544). Data were analysed to assess reliability, robustness of factor structure, convergent/discriminant validity, convergence of severity banding, and responsiveness to change. Both scales demonstrated high internal consistency at baseline and end of treatment (PHQ-9 alpha = 0.83 and 0.92; HADS-D alpha = 0.84 and 0.89). One factor emerged each for the PHQ-9 (explaining 42% of variance) and HADS-D (explaining 52% of variance). Both scales converged more with each other than with the HADS anxiety (HADS-A) subscale at baseline (P<0.001) and at end of treatment (P = 0.01). Responsiveness to change was similar: effect size for PHQ-9 = 0.99 and for the HADS-D = 1. The HADS-D and PHQ-9 differed significantly in categorising severity of depression, with the PHQ-9 categorising a greater proportion of patients with moderate/severe depression (P<0.001). The HADS-D and PHQ-9 demonstrated reliability, convergent/discriminant validity, and responsiveness to change. However, they differed considerably in how they catergorised severity. Given that treatment decisions are made on the basis of severity, further work is needed to assess the validity of the scales' severity cut-off bands.
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              The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials.

              To review the outcomes, nature and quality of published randomised controlled trials of preventive and treatment internet interventions for depression and anxiety disorders, and to document the availability of effective interventions. Previous reviews of internet interventions for mental health and related conditions were updated using an extension of the original methodology. All studies included in the original reviews and more recent eligible trials (published before June 2009) were included, together with any trials identified from a search of the health intervention web portal Beacon and the Journal of Medical Internet Research. A total of 29 reports describing 26 trials satisfied the inclusion criteria. All trials employed a cognitive behaviour therapy intervention program. Of the 26 trials, 23 demonstrated some evidence of effectiveness relative to controls. Effect size differences ranged from 0.42 to 0.65 for depression interventions involving participants with clinically significant symptoms of depression, and 0.29 to 1.74 for anxiety interventions involving participants with a diagnosed anxiety disorder. Of the five effective English-language programs, three are available to the public without charge and two can be accessed at a small cost through health practitioner referral. Internet interventions for depression and anxiety disorders offer promise for use as self-help applications for consumers or as an adjunct to usual care.
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                Author and article information

                Contributors
                Journal
                Internet Interv
                Internet Interv
                Internet Interventions
                Elsevier
                2214-7829
                27 June 2016
                September 2016
                27 June 2016
                : 5
                : 1-4
                Affiliations
                [a ]University of Cologne, Germany
                [b ]University of Erlangen, Germany
                Author notes
                [* ]Corresponding author at: Psychologie und Psychotherapie in Heilpädagogik und Rehabilitation, Universität Köln, Humanwissenschaftliche Fakultät, Klosterstraße 79b, D - 50931 Köln, Germany. Doris.Erbe@ 123456uni-koeln.de
                Article
                S2214-7829(16)30003-3
                10.1016/j.invent.2016.06.006
                6096192
                30135800
                953f22a4-10c5-407f-8fb4-08253aec7c72
                © 2016 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 January 2016
                : 3 June 2016
                : 21 June 2016
                Categories
                Full length Article

                phq-9,interformat reliability,depression,psychometric,questionnaire,assessment,computer,internet

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