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Department of Health Sciences, University of York - Mental Health Research

Ground Breaking Evidence Based Mental Health Research Announced:


Defining successful treatment outcome in depression using the PHQ-9: A comparison of methods
Dean McMillan(a), Simon Gilbody(a) and David Richards(b)
a Hull York Medical School and Department of Health Sciences, University of York, United Kingdom
b Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom

Abstract

Background

Although the PHQ-9 is widely used in primary care, little is known about its performance in quantifying improvement. The original validation study of the PHQ-9 defined clinically significant change as a post-treatment score of ≤ 9 combined with improvement of 50%, but it is unclear how this relates to other theoretically informed methods of defining successful outcome. We compared a range of definitions of clinically significant change (original definition, asymptomatic criterion, reliable and clinically significant change criteria a, b and c) in a clinical trial of a community-level depression intervention. Method Randomised Control Trial of collaborative care for depression. Levels of agreement were calculated between the standard definition, other definitions, and gold-standard diagnostic interview. Results The standard definition showed good agreement (kappa > 0.60) with the other definitions and had moderate, though acceptable, agreement with the diagnostic interview (kappa = 0.58). The standard definition corresponded closely to reliable and clinically significant change criterion c, the recommended method of quantifying improvement when clinical and non-clinical distributions overlap.

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