Testing the PHQ-9 interview and observational versions (PHQ-9 OV) for MDS 3.0

Area of Science:

• Geriatric Medicine
• Psychiatry
• Health Services Research

Background:

• Mood disorders are prevalent in nursing home populations.
• Accurate screening is crucial for timely intervention and improved resident care.
• Existing screening tools may have limitations in this population.

Purpose of the Study:

• To evaluate the feasibility and validity of the Patient Health Questionnaire-9 item interview (PHQ-9) and the Patient Health Questionnaire Observational Version (PHQ-9 OV) for mood disorder screening in nursing homes.
• To compare the performance of PHQ-9 and PHQ-9 OV against established diagnostic criteria.

Main Methods:

• A study involving 3822 nursing home residents across 71 facilities.
• Residents were assessed using either the PHQ-9 interview or PHQ-9 OV based on communication ability.
• Agreement with diagnostic standards (m-SADS, Cornell Scale) was measured using weighted kappas and correlation coefficients.

Main Results:

• The PHQ-9 was completed by 86% of residents in the feasibility sample.
• PHQ-9 showed very good agreement with m-SADS (weighted κ = 0.69) in the validation sample.
• PHQ-9 and PHQ-9 OV demonstrated superior agreement with criterion standards for depression compared to MDS 2.0 observational items, especially in cognitively impaired residents.

Conclusions:

• The PHQ-9 interview and PHQ-9 OV are feasible and valid tools for screening mood disorders in nursing home settings.
• These instruments offer improved diagnostic accuracy compared to current Minimum Data Set (MDS) 2.0 observational items.
• Staff reported enhanced insight into resident mood and improved assessment processes using the PHQ-9.