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An intensive longitudinal study on interpretation issues with the PHQ instructions.

Lennart Seizer1, Günter Schiepek2

  • 1Department of Clinical Psychology and Psychotherapy for Children and Adolescents, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Tübingen, Germany; German Center for Mental Health (DZPG), Germany.

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Summary
This summary is machine-generated.

The Patient Health Questionnaire-9 (PHQ-9) may conflate symptom frequency and burden. This study found weekly PHQ-9 scores primarily reflect a combined signal of frequency and burden, not one over the other.

Keywords:
DepressionEcological momentary assessmentPatient health questionnaire

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Psychometrics

Background:

  • The Patient Health Questionnaire-9 (PHQ-9) is a widely used depression screening tool.
  • Concerns exist regarding potential ambiguity in PHQ-9 instructions, specifically the phrase "bothered by," and its alignment with frequency-based response options.

Purpose of the Study:

  • To investigate whether weekly PHQ-9 scores correlate more strongly with symptom frequency or symptom burden in patients with depression.
  • To examine the relationship between symptom frequency and burden within the context of PHQ-9 scoring.

Main Methods:

  • An intensive longitudinal design was employed with 23 depressed patients.
  • Daily symptom presence and burden were recorded over 1652 days.
  • Weekly PHQ-9 assessments were completed over 236 weeks.
  • Mixed-effects models were utilized to analyze within- and between-person effects.

Main Results:

  • Symptom frequency and burden were highly correlated in the study sample.
  • Both frequency and burden individually predicted PHQ-9 scores when analyzed separately.
  • Neither frequency nor burden demonstrated unique predictive effects on PHQ-9 scores when considered jointly.
  • Weekly changes in PHQ-9 scores appeared to reflect a shared signal of symptom severity.

Conclusions:

  • The findings suggest that weekly PHQ-9 scores capture a combined measure of symptom frequency and burden.
  • While person-level heterogeneity in this relationship is possible, it remains uncertain based on current data.
  • These preliminary results should be considered in conjunction with the established evidence base for the PHQ-9.