Common depression screening tool may miss the mark for people living with HIV

In a study in Social Science & Medicine – Mental Health, CUNY SPH doctoral alum Dana Watnick and team sought to explore local understandings of depression and mental distress among people living with HIV in Cameroon and assess a commonly used depression screening tool.

People living with HIV are prone to depression, which often remains untreated and can negatively impact quality of life and treatment outcomes.

The researchers say low resource settings often lack clinical professionals to identify depression, therefore tools such as the Patient Health Questionnaire (PHQ-9) allow for broader depression screening. The tool is based on criteria for major depressive disorder as defined in the Diagnostic and Statistical Manual of Mental Disorder: a classification tool developed in the United States.

In the study, Watnick and team highlight important areas of concern over the PHQ-9 performance as a valid depression screener among people living with HIV. First, local expressions of depression did not align well with the hallmarks of depression in Western settings that the PHQ-9 was designed to capture. People living with HIV also described unique challenges associated with HIV, which may cause additional problems fitting their experiences into the PHQ-9 items.

Additionally, several PHQ-9 areas are prone to response errors. Incorrect interpretations of almost half of the PHQ-9 items suggests this tool may have limited validity in this population, and warrants the need for its further testing and adaptation.

“Asking people questions about their health is a central way to identify health status, concerns and potential areas for intervention,” says Watnick. “But what if we are not asking the right questions? What if the questions we ask were ‘validated’ with a different population or in a different context? This study suggests the PHQ-9 depression screener may be missing the mark for people living with HIV in a non-Western context.”

Natalia Zotova, Dana Watnick, Rogers Awoh Ajeh, Elodie Flore Tchiengang Moungang, Julie Laure Nguemo Noumedem, Guy Calvin Nko’o Mbongo’o, Kathryn Anastos, Marcel Yotebieng.

Understanding depression and the PHQ-9 items among people living with HIV: A multiple methods qualitative study in Yaoundé, Cameroon, SSM – Mental Health, Volume 6, 2024, 100353, ISSN 2666-5603.