The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: The Maastricht Study
Objectives To assess the psychometric properties and identify the best cutoff value of the Patient Health Questionnaire‐9 (PHQ‐9) for depression screening in individuals with type 2 diabetes mellitus (T2DM). Design Observational population‐based cohort study. Setting The Maastricht Study. Participan...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2016-11, Vol.64 (11), p.e201-e206 |
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| creator | Janssen, Eveline P. C. J. Köhler, Sebastian Stehouwer, Coen D. A. Schaper, Nicolaas C. Dagnelie, Pieter C. Sep, Simone J. S. Henry, Ronald M. A. van der Kallen, Carla J. H. Verhey, Frans R. Schram, Miranda T. |
| description | Objectives
To assess the psychometric properties and identify the best cutoff value of the Patient Health Questionnaire‐9 (PHQ‐9) for depression screening in individuals with type 2 diabetes mellitus (T2DM).
Design
Observational population‐based cohort study.
Setting
The Maastricht Study.
Participants
Individuals with and without T2DM (mean age 58.6 ± 8.1, 44.6% male) according to an oral glucose tolerance test (N = 2,997).
Measurements
Depressive disorder and depressive symptoms were measured using the Mini‐International Neuropsychiatric Interview (MINI) as the reference and the PHQ‐9. Cronbach alpha, Cohen's kappa and receiver operating characteristic (ROC) analyses were used. Differences in factorial structure between participants with and without T2DM were tested using multigroup confirmatory factor analysis.
Results
Based on the traditional PHQ‐9 cutoff value, 133 (4.4%) participants had depressive symptoms (PHQ‐9 score ≥10). Internal consistency of the PHQ‐9 was good (Cronbach α = 0.87 with T2DM, 0.82 without T2DM), the kappa of agreement between the PHQ‐9 and the MINI was moderate (0.40 with T2DM, 0.43 without T2DM). Area under the ROC curve for the PHQ‐9 was 0.87 in participants with T2DM and 0.88 in those without. A PHQ‐9 cutoff score of 5 provided the best sensitivity (92.3%), with acceptable specificity (70.4%), for T2DM, similar to sensitivity and specificity in individuals without T2DM. Factor analysis suggested a similar two‐factor structure in both groups (affective and somatic symptoms).
Conclusion
Patient Health Questionnaire‐9 performs well as a screening tool for depressive symptoms in individuals with and without T2DM based on the cutoff value of 5, indicating that the PHQ‐9 can be used in two‐stage screening in primary care to select individuals with T2DM for further psychological evaluation. |
| doi_str_mv | 10.1111/jgs.14388 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1835676472</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1835676472</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4548-2e7a4c301001898bf3cf95efb9c8f0fe027c82acac83364aeb3dd3e686afcaea3</originalsourceid><addsrcrecordid>eNp9kc1y0zAUhTUMDA2FBS_AaIYNLNzqz7LMjqaQlGn4mRhYamT5ulFw7CDJlLwBj41C2i6Ygbu5m--ce88chJ5SckLTnK6vwgkVXKl7aEJzzrJc0Pw-mhBCWKYkFUfoUQhrQigjSj1ER6woFOdKTNCvagX4o4kO-ojnYLq4wp9GCNENfW-ch6zEJmCDl9YD9K6_wtUwdLgdPD6HrYcQEoldjy_6xv1wzWi6gK9dsql2W8AMnztTQ4SAF9B1Lo7hFd7fXBgTond2FfEyjs3uMXrQJik8udnH6PPbN9V0nl1-mF1MX19mVuRCZQwKIywnNIVRpapbbtsyh7YurWpJC4QVVjFjjU0BpTBQ86bhIJU0rTVg-DF6cfDd-uH7PqjeuGDTa6aHYQyaKp7LQoqCJfT5X-h6GH2fvtOcqJJJmav_UlSJnDDGOE_UywNl_RCCh1ZvvdsYv9OU6H2JOpWo_5SY2Gc3jmO9geaOvG0tAacH4Np1sPu3k343W95aZgeFCxF-3imM_6ZlwYtcf30_0-XibFqdzb_oOf8NCGC1RA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1845022233</pqid></control><display><type>article</type><title>The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: The Maastricht Study</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Janssen, Eveline P. C. J. ; Köhler, Sebastian ; Stehouwer, Coen D. A. ; Schaper, Nicolaas C. ; Dagnelie, Pieter C. ; Sep, Simone J. S. ; Henry, Ronald M. A. ; van der Kallen, Carla J. H. ; Verhey, Frans R. ; Schram, Miranda T.</creator><creatorcontrib>Janssen, Eveline P. C. J. ; Köhler, Sebastian ; Stehouwer, Coen D. A. ; Schaper, Nicolaas C. ; Dagnelie, Pieter C. ; Sep, Simone J. S. ; Henry, Ronald M. A. ; van der Kallen, Carla J. H. ; Verhey, Frans R. ; Schram, Miranda T.</creatorcontrib><description>Objectives
To assess the psychometric properties and identify the best cutoff value of the Patient Health Questionnaire‐9 (PHQ‐9) for depression screening in individuals with type 2 diabetes mellitus (T2DM).
Design
Observational population‐based cohort study.
Setting
The Maastricht Study.
Participants
Individuals with and without T2DM (mean age 58.6 ± 8.1, 44.6% male) according to an oral glucose tolerance test (N = 2,997).
Measurements
Depressive disorder and depressive symptoms were measured using the Mini‐International Neuropsychiatric Interview (MINI) as the reference and the PHQ‐9. Cronbach alpha, Cohen's kappa and receiver operating characteristic (ROC) analyses were used. Differences in factorial structure between participants with and without T2DM were tested using multigroup confirmatory factor analysis.
Results
Based on the traditional PHQ‐9 cutoff value, 133 (4.4%) participants had depressive symptoms (PHQ‐9 score ≥10). Internal consistency of the PHQ‐9 was good (Cronbach α = 0.87 with T2DM, 0.82 without T2DM), the kappa of agreement between the PHQ‐9 and the MINI was moderate (0.40 with T2DM, 0.43 without T2DM). Area under the ROC curve for the PHQ‐9 was 0.87 in participants with T2DM and 0.88 in those without. A PHQ‐9 cutoff score of 5 provided the best sensitivity (92.3%), with acceptable specificity (70.4%), for T2DM, similar to sensitivity and specificity in individuals without T2DM. Factor analysis suggested a similar two‐factor structure in both groups (affective and somatic symptoms).
Conclusion
Patient Health Questionnaire‐9 performs well as a screening tool for depressive symptoms in individuals with and without T2DM based on the cutoff value of 5, indicating that the PHQ‐9 can be used in two‐stage screening in primary care to select individuals with T2DM for further psychological evaluation.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.14388</identifier><identifier>PMID: 27783384</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Aged ; Cohort Studies ; Depression - diagnosis ; Depression - epidemiology ; Depression - physiopathology ; depressive disorder ; Depressive Disorder - diagnosis ; Depressive Disorder - epidemiology ; Depressive Disorder - physiopathology ; Diabetes ; Diabetes mellitus (non-insulin dependent) ; diabetes mellitus type 2 ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes Mellitus, Type 2 - psychology ; Discriminant analysis ; Factor analysis ; Factor Analysis, Statistical ; Female ; Glucose tolerance ; Health risk assessment ; Humans ; Interview, Psychological - methods ; Male ; Mass Screening - methods ; Medical screening ; Mental depression ; Mental disorders ; Middle Aged ; Mini-International Neuropsychiatric Interview ; Netherlands ; Older people ; Patient Health Questionnaire-9 ; Population studies ; Primary care ; Psychological assessment ; Psychometrics ; Questionnaires ; ROC Curve ; screening ; Surveys and Questionnaires</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2016-11, Vol.64 (11), p.e201-e206</ispartof><rights>2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society</rights><rights>2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.</rights><rights>2016 American Geriatrics Society and Wiley Periodicals, Inc</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4548-2e7a4c301001898bf3cf95efb9c8f0fe027c82acac83364aeb3dd3e686afcaea3</citedby><cites>FETCH-LOGICAL-c4548-2e7a4c301001898bf3cf95efb9c8f0fe027c82acac83364aeb3dd3e686afcaea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.14388$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.14388$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27783384$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Janssen, Eveline P. C. J.</creatorcontrib><creatorcontrib>Köhler, Sebastian</creatorcontrib><creatorcontrib>Stehouwer, Coen D. A.</creatorcontrib><creatorcontrib>Schaper, Nicolaas C.</creatorcontrib><creatorcontrib>Dagnelie, Pieter C.</creatorcontrib><creatorcontrib>Sep, Simone J. S.</creatorcontrib><creatorcontrib>Henry, Ronald M. A.</creatorcontrib><creatorcontrib>van der Kallen, Carla J. H.</creatorcontrib><creatorcontrib>Verhey, Frans R.</creatorcontrib><creatorcontrib>Schram, Miranda T.</creatorcontrib><title>The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: The Maastricht Study</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Objectives
To assess the psychometric properties and identify the best cutoff value of the Patient Health Questionnaire‐9 (PHQ‐9) for depression screening in individuals with type 2 diabetes mellitus (T2DM).
Design
Observational population‐based cohort study.
Setting
The Maastricht Study.
Participants
Individuals with and without T2DM (mean age 58.6 ± 8.1, 44.6% male) according to an oral glucose tolerance test (N = 2,997).
Measurements
Depressive disorder and depressive symptoms were measured using the Mini‐International Neuropsychiatric Interview (MINI) as the reference and the PHQ‐9. Cronbach alpha, Cohen's kappa and receiver operating characteristic (ROC) analyses were used. Differences in factorial structure between participants with and without T2DM were tested using multigroup confirmatory factor analysis.
Results
Based on the traditional PHQ‐9 cutoff value, 133 (4.4%) participants had depressive symptoms (PHQ‐9 score ≥10). Internal consistency of the PHQ‐9 was good (Cronbach α = 0.87 with T2DM, 0.82 without T2DM), the kappa of agreement between the PHQ‐9 and the MINI was moderate (0.40 with T2DM, 0.43 without T2DM). Area under the ROC curve for the PHQ‐9 was 0.87 in participants with T2DM and 0.88 in those without. A PHQ‐9 cutoff score of 5 provided the best sensitivity (92.3%), with acceptable specificity (70.4%), for T2DM, similar to sensitivity and specificity in individuals without T2DM. Factor analysis suggested a similar two‐factor structure in both groups (affective and somatic symptoms).
Conclusion
Patient Health Questionnaire‐9 performs well as a screening tool for depressive symptoms in individuals with and without T2DM based on the cutoff value of 5, indicating that the PHQ‐9 can be used in two‐stage screening in primary care to select individuals with T2DM for further psychological evaluation.</description><subject>Aged</subject><subject>Cohort Studies</subject><subject>Depression - diagnosis</subject><subject>Depression - epidemiology</subject><subject>Depression - physiopathology</subject><subject>depressive disorder</subject><subject>Depressive Disorder - diagnosis</subject><subject>Depressive Disorder - epidemiology</subject><subject>Depressive Disorder - physiopathology</subject><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>diabetes mellitus type 2</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - psychology</subject><subject>Discriminant analysis</subject><subject>Factor analysis</subject><subject>Factor Analysis, Statistical</subject><subject>Female</subject><subject>Glucose tolerance</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Interview, Psychological - methods</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Medical screening</subject><subject>Mental depression</subject><subject>Mental disorders</subject><subject>Middle Aged</subject><subject>Mini-International Neuropsychiatric Interview</subject><subject>Netherlands</subject><subject>Older people</subject><subject>Patient Health Questionnaire-9</subject><subject>Population studies</subject><subject>Primary care</subject><subject>Psychological assessment</subject><subject>Psychometrics</subject><subject>Questionnaires</subject><subject>ROC Curve</subject><subject>screening</subject><subject>Surveys and Questionnaires</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1y0zAUhTUMDA2FBS_AaIYNLNzqz7LMjqaQlGn4mRhYamT5ulFw7CDJlLwBj41C2i6Ygbu5m--ce88chJ5SckLTnK6vwgkVXKl7aEJzzrJc0Pw-mhBCWKYkFUfoUQhrQigjSj1ER6woFOdKTNCvagX4o4kO-ojnYLq4wp9GCNENfW-ch6zEJmCDl9YD9K6_wtUwdLgdPD6HrYcQEoldjy_6xv1wzWi6gK9dsql2W8AMnztTQ4SAF9B1Lo7hFd7fXBgTond2FfEyjs3uMXrQJik8udnH6PPbN9V0nl1-mF1MX19mVuRCZQwKIywnNIVRpapbbtsyh7YurWpJC4QVVjFjjU0BpTBQ86bhIJU0rTVg-DF6cfDd-uH7PqjeuGDTa6aHYQyaKp7LQoqCJfT5X-h6GH2fvtOcqJJJmav_UlSJnDDGOE_UywNl_RCCh1ZvvdsYv9OU6H2JOpWo_5SY2Gc3jmO9geaOvG0tAacH4Np1sPu3k343W95aZgeFCxF-3imM_6ZlwYtcf30_0-XibFqdzb_oOf8NCGC1RA</recordid><startdate>201611</startdate><enddate>201611</enddate><creator>Janssen, Eveline P. C. J.</creator><creator>Köhler, Sebastian</creator><creator>Stehouwer, Coen D. A.</creator><creator>Schaper, Nicolaas C.</creator><creator>Dagnelie, Pieter C.</creator><creator>Sep, Simone J. S.</creator><creator>Henry, Ronald M. A.</creator><creator>van der Kallen, Carla J. H.</creator><creator>Verhey, Frans R.</creator><creator>Schram, Miranda T.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201611</creationdate><title>The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: The Maastricht Study</title><author>Janssen, Eveline P. C. J. ; Köhler, Sebastian ; Stehouwer, Coen D. A. ; Schaper, Nicolaas C. ; Dagnelie, Pieter C. ; Sep, Simone J. S. ; Henry, Ronald M. A. ; van der Kallen, Carla J. H. ; Verhey, Frans R. ; Schram, Miranda T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4548-2e7a4c301001898bf3cf95efb9c8f0fe027c82acac83364aeb3dd3e686afcaea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Cohort Studies</topic><topic>Depression - diagnosis</topic><topic>Depression - epidemiology</topic><topic>Depression - physiopathology</topic><topic>depressive disorder</topic><topic>Depressive Disorder - diagnosis</topic><topic>Depressive Disorder - epidemiology</topic><topic>Depressive Disorder - physiopathology</topic><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>diabetes mellitus type 2</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetes Mellitus, Type 2 - psychology</topic><topic>Discriminant analysis</topic><topic>Factor analysis</topic><topic>Factor Analysis, Statistical</topic><topic>Female</topic><topic>Glucose tolerance</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Interview, Psychological - methods</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Medical screening</topic><topic>Mental depression</topic><topic>Mental disorders</topic><topic>Middle Aged</topic><topic>Mini-International Neuropsychiatric Interview</topic><topic>Netherlands</topic><topic>Older people</topic><topic>Patient Health Questionnaire-9</topic><topic>Population studies</topic><topic>Primary care</topic><topic>Psychological assessment</topic><topic>Psychometrics</topic><topic>Questionnaires</topic><topic>ROC Curve</topic><topic>screening</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Janssen, Eveline P. C. J.</creatorcontrib><creatorcontrib>Köhler, Sebastian</creatorcontrib><creatorcontrib>Stehouwer, Coen D. A.</creatorcontrib><creatorcontrib>Schaper, Nicolaas C.</creatorcontrib><creatorcontrib>Dagnelie, Pieter C.</creatorcontrib><creatorcontrib>Sep, Simone J. S.</creatorcontrib><creatorcontrib>Henry, Ronald M. A.</creatorcontrib><creatorcontrib>van der Kallen, Carla J. H.</creatorcontrib><creatorcontrib>Verhey, Frans R.</creatorcontrib><creatorcontrib>Schram, Miranda T.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Janssen, Eveline P. C. J.</au><au>Köhler, Sebastian</au><au>Stehouwer, Coen D. A.</au><au>Schaper, Nicolaas C.</au><au>Dagnelie, Pieter C.</au><au>Sep, Simone J. S.</au><au>Henry, Ronald M. A.</au><au>van der Kallen, Carla J. H.</au><au>Verhey, Frans R.</au><au>Schram, Miranda T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: The Maastricht Study</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2016-11</date><risdate>2016</risdate><volume>64</volume><issue>11</issue><spage>e201</spage><epage>e206</epage><pages>e201-e206</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>Objectives
To assess the psychometric properties and identify the best cutoff value of the Patient Health Questionnaire‐9 (PHQ‐9) for depression screening in individuals with type 2 diabetes mellitus (T2DM).
Design
Observational population‐based cohort study.
Setting
The Maastricht Study.
Participants
Individuals with and without T2DM (mean age 58.6 ± 8.1, 44.6% male) according to an oral glucose tolerance test (N = 2,997).
Measurements
Depressive disorder and depressive symptoms were measured using the Mini‐International Neuropsychiatric Interview (MINI) as the reference and the PHQ‐9. Cronbach alpha, Cohen's kappa and receiver operating characteristic (ROC) analyses were used. Differences in factorial structure between participants with and without T2DM were tested using multigroup confirmatory factor analysis.
Results
Based on the traditional PHQ‐9 cutoff value, 133 (4.4%) participants had depressive symptoms (PHQ‐9 score ≥10). Internal consistency of the PHQ‐9 was good (Cronbach α = 0.87 with T2DM, 0.82 without T2DM), the kappa of agreement between the PHQ‐9 and the MINI was moderate (0.40 with T2DM, 0.43 without T2DM). Area under the ROC curve for the PHQ‐9 was 0.87 in participants with T2DM and 0.88 in those without. A PHQ‐9 cutoff score of 5 provided the best sensitivity (92.3%), with acceptable specificity (70.4%), for T2DM, similar to sensitivity and specificity in individuals without T2DM. Factor analysis suggested a similar two‐factor structure in both groups (affective and somatic symptoms).
Conclusion
Patient Health Questionnaire‐9 performs well as a screening tool for depressive symptoms in individuals with and without T2DM based on the cutoff value of 5, indicating that the PHQ‐9 can be used in two‐stage screening in primary care to select individuals with T2DM for further psychological evaluation.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>27783384</pmid><doi>10.1111/jgs.14388</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 0002-8614 1532-5415 |
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| subjects | Aged Cohort Studies Depression - diagnosis Depression - epidemiology Depression - physiopathology depressive disorder Depressive Disorder - diagnosis Depressive Disorder - epidemiology Depressive Disorder - physiopathology Diabetes Diabetes mellitus (non-insulin dependent) diabetes mellitus type 2 Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - psychology Discriminant analysis Factor analysis Factor Analysis, Statistical Female Glucose tolerance Health risk assessment Humans Interview, Psychological - methods Male Mass Screening - methods Medical screening Mental depression Mental disorders Middle Aged Mini-International Neuropsychiatric Interview Netherlands Older people Patient Health Questionnaire-9 Population studies Primary care Psychological assessment Psychometrics Questionnaires ROC Curve screening Surveys and Questionnaires |
| title | The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: The Maastricht Study |
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