Comparison of HADS-D, PHQ-9 and PHQ-2 for detecting depression in women with polycystic ovary syndrome

Abstract

Objective: To compare depression prevalence using the Hospital Anxiety and Depression Scale focused on depression (HADS-D), the Patient Health Questionnaire-9 (PHQ-9) and the Patient Health Questionnaire-2 (PHQ-2). It also evaluated the psychometric properties of these instruments and their agreement at different cutoff scores. Methods: A cross-sectional study with 119 women with PCOS. Participants completed all three measurements to assess depression. The study compared depression prevalence and analysed psychometric properties using Cohen's Kappa (κ), coefficient (ρ), Spearman's correlation and Cronbach's alpha (α). Results: Depression rate among PCOS women varied significantly by screening tool: 2.52%–26.89%. However, there was poor agreement and correlation between HADS-D and PHQ-9. In contrast, using cutoff scores of HADS-D ≥ 7 and PHQ-9 ≥ 10 yielded strong agreement (κ = 0.731) and correlation (ρ = 0.731). The PHQ-2 ≥ 3 had reasonable correlations with HADS-D ≥ 7 (κ = 0.596, ρ = 0.599) and PHQ-9 ≥ 10 (κ = 0.596, ρ = 0.599). Conclusions: Depression rates in PCOS women vary by evaluation technique. This study recommends a cutoff score of ≥7 for the HADS-D and ≥10 for the PHQ-9 to enhance screening accuracy among Thai PCOS women. The PHQ-2 also represents a convenient alternative tool due to its brevity and user-friendliness. We propose that the PHQ-9, with a score of ≥10, constitutes the most suitable screening instrument for Thai women with PCOS.