Evaluating the Psychometric Properties and Responsiveness to Change of Three Depression Measures in a Sample of Persons with Traumatic Spinal Cord Injury and Major Depressive Disorder
OBJECTIVES: To compare the measurement properties and responsiveness to change of the Patient Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist (HSCL-20) and the Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed with major depressive disorder (MDD). DESIGN: Secondary analysis of depression symptoms measured at 6 occasions over 12 weeks as part of a randomized control trial of venlafaxine XR for MDD in persons with SCI. SETTING: Outpatient and community settings. PARTICIPANTS: 133 individuals consented and completed the drug trial. Eligibility criteria were age at least 18 years old; traumatic SCI; and diagnosis of MDD. INTERVENTION: venlafaxine XR. MAIN OUTCOME MEASURES: Patients completed the PHQ-9 and the HSCL-20 depression scales; clinical investigators completed the HAM-D and the Structured Clinical Interview for DSM-IV Depression Module (SCID-D), which was used as a diagnostic criterion measure. RESULTS: All 3 instruments were improved with rating scale analysis. The HSCL-20 and HAM-D contained items that misfit the underlying construct and that correlated weakly with the total measures. Removing these items improved the internal consistency with floor effects increasing slightly. The HAM-D correlated most strongly with SCID-D diagnoses. Depression improvement was similar on all measures in both treatment and control groups. CONCLUSIONS: The psychometric properties of the revised depression instruments are more than adequate for routine use in adults with SCI and are responsive to clinical improvement. The PHQ-9 is the simplest instrument, with measurement properties as good as or better than those of the other instruments and requiring the fewest modifications.
Williams, R., Heinemann, A., Neumann, H., Fann, J. R., Forchheimer, M., Richardson, E., & Bombardier, C. H. (2016). Evaluating the Psychometric Properties and Responsiveness to Change of Three Depression Measures in a Sample of Persons with Traumatic Spinal Cord Injury and Major Depressive Disorder. Archives of Physical Medicine and Rehabilitation, Advance Online Publication. DOI: 10.1016/j.apmr.2016.01.017