Shortening the PHQ-9: a proof-of-principle study of utilizing Stochastic Curtailment as a method for constructing ultrashort screening instruments

Gen Hosp Psychiatry. 2015 Sep-Oct;37(5):464-9. doi: 10.1016/j.genhosppsych.2015.04.011. Epub 2015 May 14.

Abstract

Objective: In primary care, screening instruments for mental health should be ultrashort to allow for routine usage. In this paper, Stochastic Curtailment is introduced as a method for constructing ultrashort screeners.

Method: In a post hoc diagnostic accuracy study using the item scores on the Patient Health Questionnaire depression module (PHQ-9) of a large sample (N=20, 685), Stochastic Curtailment was compared with two existing ultrashort versions of PHQ-9. The first was PHQ-2 (which includes the first two items of PHQ-9), and the second was a 'two-step' method (only if the PHQ-2 screened positive were all nine PHQ items administered). For PHQ-2 and two-step, both cut scores 2 and 3 were evaluated.

Results: PHQ-2 showed the lowest and Stochastic Curtailment the highest diagnostic accuracy with reference to the classifications based on the full PHQ-9. To do so, Stochastic Curtailment used 3.08 items on average (S.D.=1.98), which was slightly less than two-step (M=3.18, S.D.=2.62) under its most accurate cut score (≥2).

Conclusions: It was concluded that Stochastic Curtailment is a promising method for constructing ultrashort screeners.

Keywords: Curtailment; Mental health; Respondent burden; Screening.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Depression / diagnosis
  • Female
  • Humans
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Primary Health Care
  • Psychometrics / instrumentation*
  • Stochastic Processes
  • Surveys and Questionnaires / standards*
  • Young Adult