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Validation and cross-cultural adaptation of the depression Patient’s Health Questionnaire – 9 in the Romanian population of patients with Type 2 Diabetes Mellitus

Authors Lupascu N, Timar B, Albai A, Roman D, Potre O, Timar R

Received 27 January 2019

Accepted for publication 9 April 2019

Published 30 May 2019 Volume 2019:12 Pages 841—849


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Antonio Brunetti

Nicoleta Lupascu,1 Bogdan Timar,2,3 Alin Albai,1,3 Deiana Roman,1 Ovidiu Potre,4,5 Romulus Timar1,3

1Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 4First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 5Department of Hematology, Municipal Emergency Hospital, Timisoara, Romania

Purpose: To validate and to evaluate the performance in depression screening of the Patient’s Health Questionnaire – 9 (PHQ-9) for Romanian patients with Type 2 Diabetes Mellitus (T2DM).
Patients and methods: In a consecutive-case, population-based, non-interventional study design 107 hospitalized patients with T2DM were enrolled. The PHQ-9 was evaluated in regard to its acceptability, ceiling and floor effect, reproducibility, and test–retest performance. Its validity was tested by comparing it to the Beck depression scale, which is a validated tool for this patient population.
Results: The PHQ-9 questionnaire had an excellent acceptability, having no non-responders for any of its questions and a median completion time of 3 mins and 12 s, a good reliability with a Cronbach’s α=0.897 [0.865–0.924] 95%CI, a good test–retest performance (Spearman’s rho =0.972; p<0.001 between two administrations of the test) without any ceiling or floor effect observed for the total score. At the same time, the score demonstrated a good validity when compared to a more complex and previously validated instrument like the Beck depression scale (Spearman’s rho =0.777; p<0.001). The limits of agreement (Bland-Altmann analysis) between the two measurements are 2.6 to −2.5 points.
Conclusion: The PHQ-9 is a valid, useful instrument for depression screening in Romanian patients with T2DM.

Keywords: questionnaire validation, depression screening, chronic diseases, screening instrument, depression in diabetes

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