Table 1.
Studies Examining Criterion or Convergent Validity of PHQ-9 in Perinatal Depression Screening
| Author Year | N | Preg nant | Post par tum | Age mean | Country | Setting* | PHQ ≥10 % | EPDS | Validity Results† |
|---|---|---|---|---|---|---|---|---|---|
| Barthel 2015 | 1024 | X | 28.7 | Ghana & Cote I’Voire | OB Hospital | 30.6 | Correlation of PHQ-9 with WHO-DAS disability = 0.41. Confirmatory factorial validity | ||
| Beck 2012 | 80 | X | 24.7 | USA | PP Clinic | 13.8 | Correlation of PHQ-9 and PDSS = 0.65 Moderate concordance (no, mild, moderate to severe depression): weighted kappa= 0.40 | ||
| Brodey 2016 | 879 | X | X | 27.6 | USA | OB Clinics | X | See Table S1 | |
| Buttner 2013 | 478 | X | 29.6 | USA | Phone survey | 100 | Of 478 who had PHQ-9 ≥ 10 and a SCID, PPV = 29.1% | ||
| Davis 2013 | 1392 | X | 28.5 | USA | Phone survey | 54.1 | Of 1011 who had PHQ-9 ≥10 and a SCID, PPV of PHQ-9 ≥10 = 54%. AUC = 0.826 | ||
| Di Venanzio 2017 | 225 | X | X | 33.9 | Italy | Psych and OB | 31.1 | Of 70 who had PHQ-9 ≥5 and a psychiatric interview PPV of PHQ-9 ≥5 = 56% | |
| Flynn 2011 | 185 | X | X | 28.2 | USA | Psychiatry | X | See Table S1 | |
| Gallis 2018 | 1731 | X | 26.7 | Pakistan | Community | 33 | See Table S1 | ||
| Gawlik 2013 | 273 | X | 32.8 | Germany | OB Clinic | 9 | X | Of 5 patients with minor or major depression by SCID, 4 and 2 exceeded EPDS ≥ 12 and PHQ-9 ≥ 10 cutoffs. Of 266 without depression, 234 and 246 were below cutoffs | |
| Gelaye 2017 | 3342 | X | 28.2 | Peru | Cohort study | X | Correlation of PHQ-9 and EPDS = 0.51 | ||
| Gjerdingen 2009 | 506 | X | 29.1 | USA | Pediatrics | See Table S1 | |||
| Green 2018 | 193 | X | 30.6 | Kenya | Community | X | See Table S1 | ||
| Hanusa 2008 | 135 | X | 29.5 | USA | Phone survey | 17 | X | Correlation of PHQ-9 & EPDS = 0.75. By DIS, AUC of PHQ-9 & EPDS = 0.80 & 0.88. | |
| Harrington 2018 | 299 | X | 26* | Malawi | HIV | X | Good concordance (no, mild, moderate, severe depression) of PHQ-9 and EPDS: weighted kappa= 0.53 | ||
| Joshi 2020 | 100 | X | 23.5 | India | AN Clinic | 15 | X | Excellent concordance between PHQ-9 and EPDS. Kappa = 0.76 | |
| Kadir 2009 | 293 | X | 31.5 | Malaysia | Hospital | X | Correlation of PHQ-9 & EPDS = 0.36 Depression prevalence using EPDS ≥ 12 and PHQ-9 ≥5 was 22.5% and 34.8% | ||
| Kulathilaka 2016 | 255 | X | 29.6 | Sri Lanka | Hospital | 14.1 | MDD prevalence by structured interview and PHQ-9 ≥ 10 similar (13.7% vs. 14.1%) | ||
| Lara 2015 | 210 | X | X | 29.5 | Mexico | AN Clinic | PHQ-9 and SCID completed at 3 time points (3rd trimester, 6 wk. and 6 mo. postpartum) Depression by SCID was 9.0%, 13.8%, and 13.3%. Depressive symptoms (PHQ-9 ≥10) prevalence was 16.6%, 17.1% and 20.0%. | ||
| Loughnan 2019 | 120 | X | 32.6 | Australia | Clinical trial | X | Responsiveness: PHQ-9 and EPDS showed similar between-group differences (effect sizes = 0.99 and 0.90). | ||
| Maliszewska 2017 | 548 | X | 30.2 | Poland | Hospital | 13.3 | X | At 4 weeks, 48 (11.7%) patients had EPDS ≥ 13, and 61 (14.9%) had PHQ-9 ≥ 10, and 30 (7.3%) exceeded both thresholds. Correlation between the two scales was 0.70 at 4 weeks and 0.60 at 3 mo. (mean=0.65) | |
| Meltzer-Brody 2014 | 91 | X | X | 28.1 | USA | Psychiatry Inpatient | X | Responsiveness. PHQ-9 and EPDS showed large effect size changes in depression over time (1.32 and 1.85, respectively) | |
| Miller 2012 | 541 | X | X | USA | Family med | 9 | PPV = 45% (13/29) by clinical interview in those with PHQ-9 ≥ 10 | ||
| Mochache 2018 | 255 | X | 20–29 | Kenya | AN Clinic | X | In 153 patients with an EPDS ≥ 10 PPV of PHQ-9 ≥ 5 = 71.9% | ||
| Nieminen 2016 | 56 | X | 34.6 | Sweden | Clinical trial | Responsiveness: Beck (BDI) and PHQ-9 showed similar effect size changes (0.29 and 0.20) in depressive symptoms over time | |||
| Orta 2015 | 1321 | X | 33.3 | USA | Cohort study | 13.7 | PHQ-9 ≥ 10 = 13.7%, DASS ≥10 = 14.2% and DASS ≥14 = 5.9% | ||
| Osok 2018 | 176 | X | 18 | Kenya | AN Clinic | 54.5 | X | At least moderate depression was present in 55% by PHQ-9 ≥10 and 58% by EPDS ≥13. | |
| Sanchez 2013 | 959 | X | 28.3 | Peru | Hospital | 7.4 | At least moderate depression was present in 7.4% by PHQ-9 ≥10 and 7.6% by DASS ≥14 | ||
| Sefogah 2020 | 350 | X | 20–34 | Ghana | PP Clinic | X | Of those with PHQ-9 ≥ 5 (n=350), 32.6% had EPDS ≥ 10. | ||
| Sidebottom 2012 | 745 | X | 23 | USA | AN Clinics | 18 | See Table S1 | ||
| Smith 2010 | 218 | X | 28.9 | USA | OB Clinics | 5 | See Table S1 | ||
| van Heyningen 2018 | 376 | X | X | 26.8 | S. Africa | AN Clinic | X | See Table S1 | |
| Weobong 2009 | 160 | X | 27.1 | Ghana | Clinical Trial | X | See Table S1 | ||
| Woldetensay 2018 | 246 | X | 24.3 | Ethiopia | Community | 18 | See Table S1 | ||
| Yawn 2009 | 481 | X | 25–29 | USA | Family med | 19 | X | EPDS and PHQ-9 concordant in 399 women (83%) including 326 normal on both scales, and 73 elevated on both | |
| Zhong 2014 | 1517 | X | 28 | Peru | AN Clinic | 29 | X | Correlation of PHQ-9 & EPDS = 0.52. At score ≥ 10 on PHQ-9 & EPDS, 29% and 28% exceeded cutpoint. Agreement between 2 scales at this cutpoint was 74%. Weighted kappa using severity categories = 0.35 |
Abbreviations: DASS = Depression Anxiety Stress Scale. DIS = Diagnostic Interview Schedule. EPDS = Edinburgh Postpartum Depression Scale. HRSD = Hamilton Rating Scale for Depression. NHW = non-Hispanic white. PDSS = Postpartum Depression Screening Scale. PPV = positive predictive value. SCID = Structured Clinical Interview for DSM.
*
AN = antenatal. PP = postpartum. OB = obstetrics
†
Criterion validity studies (n =10) are summarized in Table S1. The other 25 studies examine convergent validity.