Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population

Abstract

Objectives The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population.Design Our study has a cross-sectional design.Setting Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1).Participants The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety.Results The PHQ-9’s≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability.Conclusions The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.