Journal Mobile Options
Table of Contents
Vol. 73, No. 6, 2004
Issue release date: November–December 2004
Psychother Psychosom 2004;73:386–390

Diagnosing ICD-10 Depressive Episodes: Superior Criterion Validity of the Patient Health Questionnaire

Löwe B. · Gräfe K. · Zipfel S. · Witte S. · Loerch B. · Herzog W.
aRegenstrief Institute, Indiana University School of Medicine, Indianapolis, Ind., USA; bDepartment of General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Hospital, cDepartment of Medical Biometry, University of Heidelberg, Medical Faculty, Heidelberg, and dDepartment of Psychiatry, University of Mainz, Mainz, Germany

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Diagnosing and monitoring depression in primary care remains an issue of significant public health concern. Clinicians and researchers need to know if any one screening instrument is superior to the others in diagnosing ICD-10 depressive episodes. This study aimed to examine the criterion validity for diagnosing ICD-10 depressive episodes of the Patient Health Questionnaire (PHQ) in comparison with 2 well-established instruments, the Hospital Anxiety and Depression Scale (HADS), and the WHO Well-Being Index 5 (WBI-5). Methods: Five hundred and one medical outpatients completed the questionnaires and had a clinical interview. The presence of a depressive episode was determined with the International Diagnostic Checklists (IDCL) for ICD-10 as the criterion standard. Coefficient kappa (ĸ), sensitivities and specificities were calculated and a statistical comparison of the areas under the receiver operating characteristic curves was performed. Results: Diagnostic agreement between the questionnaires and the IDCL was moderate (ĸ = 0.34–0.56), with the highest values for the PHQ. While all 3 questionnaires had reasonable sensitivity and specificity, the operating characteristics for the PHQ were significantly superior to both the HADS and the WBI-5 (p = 0.02). Conclusions: Any of the 3 screening instruments can be recommended for clinical use. However, this is the first comparative study to demonstrate the diagnostic advantage of a particular depression-screening instrument using the ICD-10 diagnostic criteria. The superior criterion validity of the PHQ is likely attributable to its closer representation of the current concept of depressive disorders.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Ormel J, Von Korff M, Ustun TB, Pini S, Korten A, Oldehinkel T: Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994;272:1741–1748.
  2. Spitzer RL, Kroenke K, Williams JB, Patient Health Questionnaire Primary Care Study Group: Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA 1999;282:1737–1744.
  3. Perez-Stable EJ, Miranda J, Munoz RF, Ying YW: Depression in medical outpatients. Underrecognition and misdiagnosis. Arch Intern Med 1990;150:1083–1088.
  4. US Preventive Services Task Force: Screening for depression: Recommendations and rationale. Ann Intern Med 2002;136:760–764.

    External Resources

  5. Demyttenaere K, De Fruyt J: Getting what you ask for: On the selectivity of depression rating scales. Psychother Psychosom 2003;72:61–70.
  6. Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, Buchholz C, Witte S, Herzog W: Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 2004;78:131–140.
  7. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, ed 4. Washington, American Psychiatric Association, 2000.
  8. World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva, World Health Organization, 1992.
  9. Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361–370.
  10. World Health Organization: Info Package: Mastering Depression in Primary Care, Version 2.2. Copenhagen, WHO, Regional Office for Europe, 1998.
  11. Janca A, Hiller W: ICD-10 checklists – A tool for clinicians’ use of the ICD-10 classification of mental and behavioral disorders. Compr Psychiatry 1996;37:180–187.
  12. Wittchen H, Zaudig M, Fydrich T: Strukturiertes klinisches Interview für DSM-IV (SKID), Achse 1. Göttingen, Hogrefe, 1997.
  13. Löwe B, Spitzer RL, Zipfel S, Herzog W: Gesundheitsfragebogen für Patienten (PHQ-D). Manual und Testunterlagen, ed 2. Karlsruhe, Pfizer, 2002.
  14. Herrmann C, Buss U, Snaith R: Hospital Anxiety and Depression Scale (HADS-D) – Deutsche Version. Bern, Huber, 1995.
  15. Kroenke K, Spitzer RL, Williams JB: The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–613.
  16. Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.
  17. De Long ER, De Long DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics 1988;44:837–845.
  18. Löwe B, Gräfe K, Kroenke K, Zipfel S, Quenter A, Wild B, Fiehn C, Herzog W: Predictors of psychiatric comorbidity in medical outpatients. Psychosom Med 2003;65:764–770.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50