Responsiveness of PROMIS and Patient Health Questionnaire (PHQ) Depression Scales in three clinical trials

Kurt Kroenke, Timothy E. Stump, Chen X. Chen, Jacob Kean, Teresa M. Damush, Matthew J. Bair, Erin E. Krebs, Patrick O. Monahan

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: The PROMIS depression scales are reliable and valid measures that have extensive normative data in general population samples. However, less is known about how responsive they are to detect change in clinical settings and how their responsiveness compares to legacy measures. The purpose of this study was to assess and compare the responsiveness of the PROMIS and Patient Health Questionnaire (PHQ) depression scales in three separate samples. Methods: We used data from three clinical trials (two in patients with chronic pain and one in stroke survivors) totaling 651 participants. At both baseline and follow-up, participants completed four PROMIS depression fixed-length scales as well as legacy measures: Patient Health Questionnaire 9-item and 2-item scales (PHQ-9 and PHQ-2) and the SF-36 Mental Health scale. We measured global ratings of depression change, both prospectively and retrospectively, as anchors to classify patients as improved, unchanged, or worsened. Responsiveness was assessed with standardized response means, statistical tests comparing change groups, and area-under-curve analysis. Results: The PROMIS depression and legacy scales had generally comparable responsiveness. Moreover, the four PROMIS depression scales of varying lengths were similarly responsive. In general, measures performed better in detecting depression improvement than depression worsening. For all measures, responsiveness varied based on the study sample and on whether depression improved or worsened. Conclusions: Both PROMIS and PHQ depression scales are brief public domain measures that are responsive (i.e., sensitive to change) and thus appropriate as outcome measures in research as well as for monitoring treatment in clinical practice. Trial registration

Original languageEnglish (US)
Article number41
JournalHealth and Quality of Life Outcomes
Issue number1
StatePublished - Dec 2021

Bibliographical note

Funding Information:
This work was supported by a National Institute of Arthritis and Musculoskeletal Disorders R01 award to (R01 AR064081) and Department of Veterans Affairs Health Services Research and Development Merit Review awards (IIR 10-128 and IIR 11-125), and VA HSRD QUERI Service Directed Project SDP-10-379). Additional support was provided by the National Institute of Nursing Research under award number 5T32 NR007066, the Indiana University–Purdue University Indianapolis Enhanced Mentoring Program with Opportunities for Ways to Excel in Research (EMPOWER) Grant, KL2TR001106 and UL1TR001108 grants funded by the National Center for Advancing Translational Sciences Clinical and Translational Sciences Award, and Department of Veterans Affairs Rehabilitation Research and Development Career Development Award (IK2RX000879). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veteran Affairs.

Publisher Copyright:
© 2021, The Author(s).


  • Depression
  • PHQ-9
  • Psychometrics
  • Responsiveness
  • Sensitivity to change


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