Academic journal article Journal of Nursing Measurement

Psychometric Properties of the Patient Health Questionnaire-9 in Patients with Heart Failure and Gastrointestinal Symptoms

Academic journal article Journal of Nursing Measurement

Psychometric Properties of the Patient Health Questionnaire-9 in Patients with Heart Failure and Gastrointestinal Symptoms

Article excerpt

Background and Purpose: Patients who have coexisting medical conditions tend to be more depressed. The purpose of this study was to examine the reliability, validity, and dimensionality of the Patient Health Questionnaire-9 (PHQ-9) in patients with heart failure and gastrointestinal (GI) symptoms. Methods: The cross-sectional data for this secondary analysis were collected in four studies. Cronbach's alpha was used to examine reliability. Concurrent validity with the Beck Depression Inventory-II (BDI-II) was examined. Results: Cronbach's alpha for the PHQ-9 was .87. Concurrent validity with BDI-II was excellent (r = .78, p < .01). Conclusions: The evidence from this study supports the reliability and validity of the PHQ-9 as a measure of depression in patients with heart failure and GI symptoms.

Keywords: heart failure; depressive symptoms; psychometrics; gastrointestinal disease

Approximately 9.5% of the adult population in the United States suffers from depression. In 2005, nearly 10% of all hospital admissions were associated with depression; 2.9 million hospital admissions resulted in a cost of $21.8 billion (Agency for Healthcare Research and Quality, 2007). Depression is associated with several psychosocial factors including poor social support (Scherer et al., 2007), anxiety (McLaughlin, Khandker, Kruzikas, & Tummala, 2006), and hostility (Heponiemi et al., 2006). Poor perceived social support predicted depression in 496 adolescent girls (Stice, Ragan, & Randall, 2004). Depression often coexists with chronic illnesses such as heart disease, cancer, and diabetes (Den Oudsten, Van Heck, Van der Steeg, Roukema, & De Vries, 2009; Knol, Geerlings, Grobbee, Egberts, & Heerdink, 2009; Pozuelo et al., 2009). The prevalence of depression-assessed using the Center for Epidemiologic Studies Depression Scale (CES-D)-in patients with heart failure ranges from 24% (Kato et al., 2012) to 65% (Ploux et al., 2012). In the 12 months after their initial heart failure diagnosis, 14.7% of patients with heart failure were diagnosed with depression (Cully, Johnson, Moffett, Khan, & Deswal, 2009). Patients with heart failure and depression have lower compliance with medication regimens, increased mortality, and a poorer quality of life than those who do not have coexisting depression (Nair, Farmer, Gongora, & Dehmer, 2012; O'Connor et al., 2008). Patients with heart failure often have gastrointestinal (GI) symptoms caused by congestion of the gut and side effects of medications, which can lead to nausea, diarrhea, and constipation (MacCallum & Hughes, 2010; McMillan, 2002). GI symptoms such as constipation, diarrhea, nausea, and heart burn are significantly related to depressive symptoms (Bodukam et al., 2011; Mussell et al., 2008). Low serotonin is also related to depressive symptoms, pain, irritable bowel syndrome, and constipation (Ohayon, 2009; Spiller, 2008; Tack & Muller-Lissner, 2009). Therefore, various symptoms associated with depression can be understood as symptom clusters caused by low serotonin levels.

BACKGROUND AND CONCEPTUAL FRAMEWORK

The Patient Health Questionnaire-9 (PHQ-9) is a screening tool for depression. Major depressive disorder is defined as having depressed mood, markedly diminished interest or pleasure in all or almost all activities, significant (more than 5% of body weight) weight loss or gain, significant increase or decrease in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or inappropriate guilt, diminished concentration or indecisiveness, and recurrent thoughts of death or suicide. The presence of five symptoms for a minimum of 2 weeks is required for the diagnosis of clinical depression: One of the symptoms should be depressed mood or loss of interest (American Psychiatric Association, 2000). The reliability and validity of the PHQ-9 have been tested in people with ischemic heart disease (Esler, Johnston, & Thomas, 2007), heart failure (Hammash et al. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.