The Feasibility of Using the Spanish PHQ-9 to Screen for Depression in Primary Care in Honduras

Background: The Patient Health Questionnaire depression module (PHQ-9) is a brief (10 items) screening and monitoring measure designed for use in primary care settings that operationalizes most of the DSM-IV and ICD-9 diagnostic criteria for major depression. In the United States, the PHQ-9 has become the recommended depression measure in primary care settings. However, there are no published reports of its use in developing countries and no reports of the feasibility of using the Spanish version of the PHQ-9 to screen for depression.

Method: During a medical brigade in October 2001, we tested the feasibility of using the Spanish PHQ-9 to screen for major depression in primary care clinics. A team of U.S. and Honduran physicians and medical students assessed 199 mothers of children under 10 years of age as part of a depression prevalence study in 5 rural sites.

Results: The PHQ-9 proved easy to administer to this population of poor, rural, young, and mostly illiterate Honduran women who had never participated in research before. Rater training required about 30 minutes of instruction for this group of physicians and medical students, plus occasional questions on the first day of use. Duration of administration of the PHQ-9 by interview ranged from 3 to 15 minutes. No items required major modification for cultural differences. The PHQ-9 identified a rate of 15% for major depression in this sample, and the PHQ-9 results showed a sensitivity of 77% and a specificity of 100% compared with the Structured Clinical Interview for DSM-IV mood disorders module.

Conclusion: Like the English PHQ-9, the Spanish PHQ-9 is an efficient and reliable screening measure for major depression in primary care. It is useful as a research measure for estimating the prevalence of major depression and as an aid to the primary care clinician in rural Honduras.