The Positive Predictive Value of the PHQ-2 as a Screener for Depression in Spanish-Speaking Latinx, English- Speaking Latinx, and Non-Latinx White Primary Care Patients

Although the Patient Health Questionnaire 2 (PHQ-2) is frequently used to screen for depressive disorders in primary care patients, there is little information about its psychometric properties in diverse populations. The present study evaluated the positive predictive value (PPV) of the PHQ-2 in three groups of primary care patients at a federally qualified health center (78% female, M age = 42.73 years, range 18–78): Spanish-speaking Latinxs (n = 490), English-speaking Latinxs (n = 134), and non-Latinx Whites (n = 690). Universal screening with the PHQ-2 of consecutive adult primary care patients took place during a 5-month period. Any “yes” response to the 2 items on the PHQ-2 resulted in the administration of the full PHQ-9. Scores ≥10 on the PHQ-9 were used to index probable major depressive disorder. Data for this study were extracted from patient electronic medical records. Binary logistic regressions indicated the PPV of the PHQ-2 overall was 69.1%. PPVs were highest in English-speaking Latinx patients (73.1%) and non-Latinx White patients (72.8%), and significantly lower in the Spanish-speaking Latinx patient group (62.9%). Discrepancies in PPVs remained even after controlling for demographic variables (age, gender, uninsured). The PHQ-2 had a 35% greater false discovery rate in Latinxs who are less acculturated, as indexed by self-reported preferred language, but performs comparably in acculturated Latinx and non-Latinx White groups. The PHQ-2 may overidentify mood disorders in Spanish-speaking primary care patients.