Validity of the PHQ-2 questionnaire for the detection of depression in Colombian health personnel during Covid-19.

ABSTRACT

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Background: Depressive symptomatology in health professionals associated with viral crises is highly prevalent globally, being its detection a priority. Therefore, the objective of this research was to analyze the convergent validity and internal consistency of the Patient Health Questionnaire (PHQ-2) in healthcare professionals. Method: E-Health study where cross-sectional data was collected online (n = 725), from 281 general practitioners, 237 specialist doctors and 207 nurses during the Colombian quarantine, between April 20 and August 10, 2020. Average age 41.3 years (± 8.76). 38.4% were men (278) and 61.6% women (447). 66.1% of health personnel treated patients infected with coronavirus and 33.9% did not provide these services. The 9-item version of the PHQ was administered, validated in the Colombian population together with the 2-item version of the PHQ. Results: A high correlation was found between the scales (r = .860, P <0.001), demonstrating the convergent validity of the PHQ-
2 to measure depressive symptomatology. The internal consistency of the PHQ-2 was adequate, with a Cronbach’s Alpha of 0.80 (I.C. = 0.76 - 0.83). Conclusions: The PHQ-2 has adequate psychometric standards of reliability and validity, so its rapid administration, easy qualification and interpretation, makes it a reliable and valid instrument for the rapid detection, without work overload, of depressive symptoms in doctors and nurses whether or not they care for patients with viral outbreaks.

Key words: validation, PHQ-2, healthcare professionals.

INTRODUCTION

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Depression  is  a  common  mental  disorder  and the  principal  cause  of  disability  worldwide(1). The   natural   disaster   and   the   pandemics   are known as stress factors, they have an impact on physical integrity, emotional welfare, and mental health, affect mood and develop depressive symptomatology(2). Thus, from the covid-19 arose, this had an important stress factor for laypeople and the communities, but it is more significant and traumatic for health professionals.(3,4)

Previous  studies  had  presented  reports  of mental affectation in the health providers for medical attention. During the severe acute respiratory syndrome (SARS) of 2003 and the Ebola crisis in 2014, was reported an increase in stress symptoms, anxiety, and depression among health workers(5), founding a long time an effect of psychiatric morbidity after viral outbreaks(6,7). The global evidence reveals stress factors and anxiety associated with different epidemiological phases of covid-19, triggering psychological  problems  such  as  depression  in the sanitary personnel.(8,9)

Colombia has been an important infection focus(10) The hospital infrastructure problems to resist the high volume of patients attended for coronavirus, the difficulty to access to biomedical equipment for security, and work overload, among others, it is a challenger for health care personnel, aggravating problems of mental health.(11)

These evidence collections suggest the necessity for early detection of depressive symptomatology, using accurate and brief instruments to give support for an early intervention to prevent immediate and enduring implications for sanitary workers.(12)

The Patient Health Questionnaire (PHQ-2) is a brief scale formed by two items, which is based on the Spanish version constituted by nine items(13) and it is used to identify depressive symptoms. Further, the PHQ is shorter than the majority of scales of depression(14,15)  and it is considered the better screening instrument for depression and primary health care because of its fast application, clinical accuracy, public use, and easy of application, rating, and interpret(9,16). Both versions, the PHQ-2 and the PHQ-9 are translated into more than 20 languages, they have been used in many contexts and have excellent psychometric proprieties(17,18). In Colombia has been analyzed the reliability and dimensions of the PHQ-9 in university students(19), and it was validated on discrimination in usuaries of primary health care.(20)

Concerning  the  PHQ-2,  recently  was  informed of its intern consistency, convergent and criterion validity in 243 adults who assisted at primary health care centers(21). However, there are no descriptions of psychometric indicators for the medical population. Thus, the objective of the present study was to analyze the convergent validity of PHQ-2 compared to the PHQ-9, and the intern consistency of instruments in sanitary professionals during the Colombian quarantine of covid-19.

METHOD

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e-Health study, which the data is collected transversely  online  (n=725)  from  professionals of medicine and nursing during Colombian quarantine for covid-19 in the second semester of
2020.

Participants

Health workers of hospitals and clinics from Colombia  were  invited  to  participate  in  the study making a questionary in Google sent by institutional  emails  and  social  networks,  who were involved and not involved in the health care of covid-19 patients. 725 sanitary professionals (aged 31-51; ME: 41, 3 years ± 8,76) answered the questionary with informed consent. Of 278 men (38.4%) and 447 women (61.6%), 66,1% of them worked with patients infected by a coronavirus and 33.9% did not work with this kind of patient. The 38% were general physicians (281,3), 32,7% were medical specialists (237,0) and the 28,5% nurses (207). 436 worked in private clinics and 289 in the public system.

Instrument

The PHQ-9 is an instrument that asses*s*eps<d0.e0p1 ressive symptoms through four kinds of answers in Likert format between 0 to 3 points (any day; some days; more than half of the days and almost every day). It entails 9 questions that let to rate the discomfort levels and classify t.he escrvieprtivye aonfddIenpterrenssailon(20). The brief version is formed with two items (PHQ- 2)  that  rate  the  frequency  of  depressive  mood and the anhedonia (loss of pleasure sense for pleasurable behaviors) from the lasted two weeks; it has reported sensibility of 83% and specificity of 92%(22).  The last Colombian validity in laypeople has reported a sensibility of 87% and a specificity of 73% over a cut-off score ?2, and the area under the curve is 89% (95% CI 0.84-0.93)(23). The assessment online of the PHQ-2 was made in 1,30 minutes.

Statistical analysis

The  analysis  consisted  to  find  the  convergent
validity of the PHQ-2 and comparing the PHQ-
2  and  the  PHQ-9  to  demonstrate  that  PHQ-2 is  mediated  by  the  same  theoretical  construct. applied to the Colombian sanitary professionals.

Ethical aspects

The      health  care     personnel        were    informed

RESULTS

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Table 1 presents descriptive statistics such as median, standard deviation, Kurtosis, asymmetry, and confidence intervals based on items median of the PHQ-2.

Convergent validity

In the Table 2, the convergent validity of the PHQ-
2 is observed in high correlations to the PHQ-9 (r=.860, P<0.001).

Reliability analysis

The  internal  consistency  measure  of  the  PHQ-

2 was adequate, the Cronbach’s alpha was 0.80 (I.C.= 0.76 – 0.83) and the omega index was 0.76. In Table 3 can be observed that the Alpha does not increase significatively if one of the items is eliminated. The item-total correlations show a range between .910 and .924 respectively for each item, which is over the minimum required of .300.

DISCUSSION

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In the present study the reliability and convergent validity of the PHQ-2 were analyzed in physicians and  nurses  during  the  second  infect  wave  by a   coronavirus   in   Colombia.   The   prelaminar results  arrogated  a  strong  correlation  between the PHQ-2 and the PHQ-9, demonstrating the convergent  validity  of  the  PHQ-2  (r=,860; p<0,01) for the theoretical construct of depressive symptomatology. On other hand, the reliability of PHQ-2 was an alpha the Cronbach of 0.80 (I.C.=
2.03 – 2.30) and a high range in the correlation item-total scale (.910 and .924); this means that this instrument is consistent and adequate for identify the depressive symptomatology in the sanitary professional assessed such as who worked with patients infected for covid-19 and with patients without this kind of infection.

At a global level, the use of the PHQ-2 is generalized(17,24),  due that this instrument is easy to apply, rating, and interpret with adequate psychometric  proprieties  for  identifying depressive symptomatology without generating pression to health workers(17). In Latin-American, the validity and use of the PHQ-2 had been confirmed for detecting emotional disorders in different  sceneries  such  as  primary  health  care and clinic attention(26). Also, this instrument had used in patients diagnosed with Parkinson’s(18), infected by VIH and consume drugs(27,28), in individuals that have positive arthralgia associated with Chikungunya(29), for assessing the prevalence of depression in subjects intervened for chronic tabaco consume(30)  and university students(31), demonstrating optimal psychometric indicators and excellent clinic utility.(32)

In Colombia, recently it was informed the validity of the PHQ-2 in a sample of 243 subjects who were attended for different causes in general ambulatory  consult  of  primary  health  care(21). The internal consistency through the Cronbach’s alpha in Scoppetta’s study was lower (0.76) than in the present research (0.80). Likewise, the correlation indicators of this study were higher (r=.860, P<0.001) than Scoppeta’s analysis (r=0,63; P<0.001). This result is related to the study design did not use cases and controls, but rather a small sample of laypeople. However, in this study, adequate indicators are exposed over the general clinic utility (0.89), sensibility (0.87), and specificity (0.74) of the PHQ-2 for detecting depression  in  laypeople.  Therefore,  our  study gives positive evidence to this instrument due to the different and high sample.

Despite the adequate psychometric indicators exhibited in the PHQ-2 for detecting depressive symptomatology, is necessary to reveal some limitations  of  this  research.  The  methodology e-Health imposed two challengers. The first is that  it  cannot  ensure  that  individuals  who  are not health workers completed the evaluation online.

Nevertheless, the identity and professional roles, let minimized this situation. The second is the constraints  of  online  connection  and  internet access because this implies more participation of urban professionals rather than other workers who worked in areas, where the coverage is deficient. But the benefit of the implementation of e-Health gives an account of this clinic’s value in contexts with and without viral outbreaks.(32)

Despite these limitations, the PHQ-2 has excellent psychometric standards of reliability and validity, and it is easy to apply as well to rating and interpretation, being a reliable and valid instrument for fast detection of depressive symptoms in physicians and nurses without overload work, who care and not care patients infected in conditions of viral outbreaks.

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