Validation of the patient health questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy

Jaivir S. Rathore, Lara E. Jehi, Youran Fan, Sima I. Patel, Nancy Foldvary-Schaefer, Maya J. Ramirez, Robyn M. Busch, Nancy A. Obuchowski, George E. Tesar

Research output: Contribution to journalArticlepeer-review

67 Scopus citations


Objective: This study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. Methods: Tertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a "gold standard" instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy. Results: The calculated areas under the ROC curves for the PHQ-9 (n = 172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p = 0.002) but not different from the PHQ-9/CA (p = 0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n = 127; 0.930 vs 0.934; p = 0.864). Significance: The PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.

Original languageEnglish (US)
Pages (from-to)215-220
Number of pages6
JournalEpilepsy and Behavior
StatePublished - Aug 2014

Bibliographical note

Funding Information:
This publication was made possible, in part, by the Clinical and Translational Science Collaborative of Cleveland (CTSC) , KL2TR000440 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health (NIH) Bethesda, MD, USA and NIH roadmap for Medical Research (to RMB). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Additional funding in support of this research was provided by the Cleveland Clinic Epilepsy Center , Cleveland, OH, USA, and there were no other external funding sources.


  • Depression
  • Epilepsy/seizures
  • Mini-international neuropsychiatric interview (MINI)
  • NDDI-E
  • PHQ-9


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