Abstract:
Background: Depression is the most common neuropsychiatric problem among people living
with HIV (PLWH). Given the lack of mental health professionals, there is a need to develop a
brief and culturally valid instrument to screen for depression among PLWH that can be
administered by nurses in order to improve detection.
Objective: This study aimed at assessing the validity of Patient Health Questionnaire (PHQ-9)
and Kessler (K-10 and K-6) scales for detecting depression among PLWH attending HIV
services in Ethiopia.
Methods: Content, criterion and convergent validity of the Amharic versions of the PHQ-9, K-6
and K-10 were assessed. Criterion validation was conducted on 145 adult PLWH receiving
follow-up out-patient care at Jimma University Specialized Hospital (JUSH).The Mini
International Neuropsychiatric Interview (MINI) was the gold standard measure, administered by
psychiatry nurses.
Results: The area under the Receiver Operating Characteristic curve (AUROC) of PHQ-9
against MINI cases of major depression was 0.96 (95% CI 0.93 to 0.99). The AUROC of
Kessler-10 and Kessler-6 was 0.85 (95% CI 0.78 to 0.92) and 0.84 (95% CI 0.77 to 0.91),
respectively. The optimal cut off point for PHQ-9 was found to be 5/6 which gave a sensitivity of
87.2% and specificity of 83.7%. For Kessler-10 the optimal cut-off point was 4/5 which gave a
sensitivity of 85.1% and specificity of 77.6 %. At the optimal cutoff point of 3/4, K-6 generated
a slightly lower sensitivity than K-10 and better specificity of 81.6 %. The spearman correlation
coefficients for PHQ-9, K-10 and K-6 with a scale of functional impairment were 0.74, 0.73 and
0.73, thus indicating good convergent validity.
Conclusion: All three instruments were found to be valid scales to detect major depression
among individuals living with HIV. The PHQ-9 had the best psychometric properties overall.
There was a little difference in the overall performance of the K-10 and. K-6.
Recommendation: The PHQ-9 instrument is a good candidate scale for routine screening for
depression by nurses working at the HIV clinic. However, studies to evaluate the acceptability
and feasibility of depression screening in practice are required.
