Jin-Jin Tjung

Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan

PURPOSE The aim of this study was to determine the reliability and validity of a Chinese version of the Patient Health Questionnaire (PHQ-9) for the purpose of screening major depressive disorder (MDD) among primary care patients in Taiwan. METHOD A total of 1954 primary care patients completed the PHQ-9. Patients (n = 1532) were interviewed using the Schedule for Clinical Assessments in Neuropsychiatry and 17-item of Hamilton Rating Scale. Subsample cases were retested within 2 weeks. RESULTS The PHQ-9 had a good internal consistency (α = .80) and test-retest reliability (intraclass correlation coefficient = 0.87). A principal component factor analysis yielded 1-factor structure, which accounted for a total of 42.0% of the variance. The PHQ-9 was significantly correlated with the external validators such as the 17-item of Hamilton Rating Scale and the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire (P < .001). Using the Schedule for Clinical Assessments in Neuropsychiatry interview as the criterion standard, a PHQ-9 score of 10 or higher had a sensitivity of 0.86 and a specificity of 0.94 for recognizing MDD. The screening accuracy of the 2 items version, PHQ-2, was also satisfactory (scores ≥ 2: sensitivity 0.88; specificity 0.82). The single-question screen, PHQ-1 (depressed mood), was 78% sensitive and 93% specific for detecting MDD (score ≥ 2). CONCLUSION The PHQ-9 and its 2 subscales, PHQ-2 and PHQ-1, seem reliable and valid for detecting MDD among Chinese primary care patients.

The effectiveness of Culturally Sensitive Collaborative Treatment of depressed Chinese in family medicine clinics: A randomized controlled trial

OBJECTIVE To investigate whether the Culturally Sensitive Collaborative Treatment (CSCT) would improve outcomes for patients with major depression who were managed in family medicine clinics in Taiwan. METHOD A single-blinded randomized trial was conducted in 26 family medicine clinics. Patients with major depressive disorder were consecutively randomized to either CSCT or treatment as usual (TAU). The primary outcome was the severity of depression. Secondary outcomes included treatment response, treatment remission, quality of life, and medication adherence. Outcomes were compared using hierarchical linear models (mixed-effects models) from baseline to 26-week follow-up assessments. RESULTS Of the 280 patients, 141 were randomized to TAU and 139 to CSCT. Hierarchical linear modeling revealed that the CSCT group displayed significantly greater improvement in depressive symptoms over the study period when compared to the TAU group (B=-2.60, P<0.001). The odds of achieving the response, remission, and medication adherence were significantly greater for the CSCT group compared to the TAU group (odds ratio=4.65, 4.12, and 2.06, respectively; all Ps<0.05). However, both groups did not differ significantly in quality of life. CONCLUSION CSCT is effective in improving treatment outcomes for major depression in family medicine clinics in Taiwan.