Development and Validation of the Maudsley Modified Patient Health Questionnaire (MM-PHQ-9)

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Background: The Patient Health Questionnaire (PHQ-9) is a widely used measure of depression in primary care. It was, however, originally designed as a diagnostic screening tool and not for measuring change in response to antidepressant treatment. Although the Quick Inventory of Depressive Symptomology (QIDS-SR-16) has been extensively validated for outcome measurement, it is poorly adopted in UK primary care and, although free for clinicians, has licensing restrictions for healthcare organization use.
Aims: To develop a modified version of the PHQ-9, the Maudsley Modified-PHQ-9 (MM-PHQ-9), for tracking symptom changes in primary care. We tested the measure’s validity, reliability and factor structure.
Method: A sample of 121 participants recruited across three studies comprised 78 participants with major depressive disorder (MDD) and 43 controls. MM-PHQ-9 scores were compared with the QIDS-SR-16 and Clinical Global Impression (CGI-Improvement) for concurrent validity. Internal consistency of the scale was assessed, and principal component analysis conducted to determine the items’ factor structure.
Results: The MM-PHQ-9 demonstrated good concurrent validity with the QIDS-SR-16, and excellent internal consistency. Sensitivity to change over a 14-week period was d = .41 compared with d = .61 on the QIDS-SR-16. Concurrent validity between the paper and mobile app MM-PHQ-9 was r = .67.
Conclusions: These results indicate that the MM-PHQ-9 is a valid and reliable measure of depressive symptoms in paper and mobile app format although further validation is required. The measure was sensitive to change, demonstrating suitability for use in routine outcome assessment.
Trial registration numbers: Antidepressant Advisor Study 1/3:NCT03628027/ NCT04342299; NeuroMooD:ISRCTN10526888
Original languageEnglish
JournalBritish Journal of Psychiatry Open
Early online date2 Jul 2021
Publication statusE-pub ahead of print - 2 Jul 2021


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