Feasibility and factors affecting the diagnostic accuracy of a self-administered PHQ-9 for depression screening at Mukono Church of Uganda Hospital HIV Clinic

Abstract

Background: Comorbid depression is three times more prevalent among people living with HIV in Uganda, yet its diagnosis is still a challenge due to multiple factors such as inadequate health care work force that results into heavy workload and less attention. A self-administered PHQ-9 tool may be useful in improving screening for depression and depression treatment monitoring among people living with HIV in Uganda. However, there are limited studies on the feasibility and accuracy of a self-administered PHQ-9 in Uganda. Objective: The study aimed at determining the feasibility, accuracy and factors affecting the diagnostic accuracy of a self-administered PHQ-9 for depression screening at Mukono Church of Uganda (MCOU) hospital HIV clinic. Methods: A cross-sectional study among people living with HIV who attended care at (MCOU) Hospital. Participants self-administered the PHQ-9 and thereafter were assessed by a trained clinician who was using a DSM-5 checklist as reference standard. Among those who picked the questionnaire from the reception, the number of those who accepted to self-administer the questionnaire, those willing but unable to self-administer, and time taken to self-administer were recorded. The completion rate was also recorded. The PHQ-9 scores and the psychiatric diagnoses for each participant were recorded. Clinicians were blinded to the self- administered PHQ-9 findings. Logistic regression was used to evaluate the factors that affect diagnostic accuracy. Results Of PLHIV, 30.7% were found to be positive for depression as per the DSMV-5. The average time taken to self-administer was 9.4 minutes, standard deviation of 3.8. About 88% were accepted to complete the tool, and the completion rate of 86% among those who attempted. Majority of the study participants found it easy to self-administer the PHQ-9. The study revealed a high accuracy of the self-administered PHQ-9 with a sensitivity of 82% and specificity of 68.7% at an optimum cut off of 5. Older participants above 50 years were 43% less likely to accurately complete the PHQ -9 compared to participants 18 to 29 years. Conclusion: A self-administered PHQ-9 has a considerably high accuracy and is feasible for depression screening among PLHIV. However, Older PLHIV 50 years and above could benefit more from a clinicians help while completing the PHQ-9.