Clinical Utility of the Patient Health Questionnaire–9 in the Assessment of Major Depression after Broad Spectrum Traumatic Brain Injury

Publication date: Available online 21 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jacobus Donders, Adriene Pendery
ObjectiveTo determine the predictive validity of the Patient Health Questionnaire–9 (PHQ–9) when screening for symptoms of depression following traumatic brain injury.DesignRetrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months.ParticipantsPersons with mild to severe traumatic brain injury who were referred for neuropsychological evaluation within 1–12 months (N = 137).InterventionsNot applicable.Main Outcome MeasuresPHQ–9 and Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI–2–RF).ResultsPHQ–9 scores > 10 had a sensitivity of 91.7 and a specificity of 60.2 in predicting a diagnosis of major depression. Correlations between PHQ–9 scores and MMPI–2–RF scales Demoralization (0.64) and Low Positive Emotions (0.48) ranged from large to medium. Premorbid outpatient psychiatric treatment was the most consistent predictor of PHQ–9 elevations as well as final diagnoses of major depression.ConclusionsThe PHQ–9 has adequate clinical utility as a screening instrument for depression in outpatients with traumatic brain injury. Elevations on this instrument can, however, not be automatically be attributed to neuropathology; especially not in the context of premorbid psychiatric dysfunction. Clinicians should conduct more thorough follow-up assessment in those with highly elevated PHQ–9 scores.



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