Limitations of the Patient Health Questionnaire in Identifying Anxiety and Depression in Community Mental Health: Many Cases are Undetected

Objective: To determine the concordance between the Structured Clinical Interview for DSM-IV (SCID) and the Patient Health Questionnaire (PHQ) in diagnosing anxiety and depressive disorders. Method: Fifty women seeking psychiatric services for their children at two mental health centers in western Pennsylvania were assessed for anxiety and depressive disorders using the SCID and the PHQ. Results: Twenty-five women met SCID criteria for at least one anxiety disorder, 11 (44%) of whom the PHQ failed to identify. The PHQ was particularly limited in identifying individuals with anxiety disorders other than panic disorder. Seventeen women met SCID criteria for at least one depressive disorder, 6 (35%) of whom the PHQ failed to identify. The PHQ was particularly limited in identifying depressed individuals with dysthymia. Conclusions: Caution should be used when screening for anxiety and depression with the PHQ. Implications for improving diagnostic accuracy in social work practice are discussed.

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