Sensitivity and specificity of clinician administered screening instruments in detecting depression among HIV-positive individuals in Uganda

AIDS Care. 2013;25(10):1245-52. doi: 10.1080/09540121.2013.764385. Epub 2013 Feb 11.

Abstract

Depressive disorders are highly prevalent in Africa where diseases such as HIV/AIDS are common. The aim of this study was to assess the validity of commonly used depression screening instruments in a setting characterized by low literacy, where patients may not be able to self-administer depression scales. We explored the validity of the Patient Health Questionaire-9 (PHQ-9), Centre for Epidemiological Surveys for Depression (CES-D), and the Kessler-10 (K-10), using the Mini International Neuropsychiatric Instrument (MINI) as a gold standard in 368 persons living with HIV/AIDS (PLWHA) in Uganda. The shorter versions of the K-10 and PHQ-9 were extracted to assess their performance in comparison to the longer versions. We used STATA 11.2 to analyze the data. The prevalence of a MINI defined depression in this patient sample was 17.4%. The three instruments all performed well, with areas under the curve (AUC) ranging from 0.82 to 0.96. The PHQ-9 showed the best performance characteristics with an AUC of 0.96, a sensitivity of 91.6%, and specificity 81.2%. The extracted versions performed more modestly. All three instruments showed good properties as screening tools; the PHQ-9 has particularly high sensitivity and specificity, and so can be considered useful for screening HIV-positive patients for depression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Depressive Disorder / complications
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology*
  • Female
  • HIV Seropositivity / complications
  • HIV Seropositivity / epidemiology
  • HIV Seropositivity / psychology*
  • Home Care Services, Hospital-Based / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Prevalence
  • Psychiatric Status Rating Scales* / standards
  • Reproducibility of Results
  • Sampling Studies
  • Sensitivity and Specificity
  • Surveys and Questionnaires
  • Uganda / epidemiology