ArticleBMC psychiatry2020
Validity and item response theory properties of the Patient Health Questionnaire-9 for primary care depression screening in Mozambique (PHQ-9-MZ).
Article in BMC psychiatry, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.
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Who cites it
30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- A systematic review and meta-analysis of diagnostic test accuracy of mental health screening tools applicable to adolescents in sub-Saharan Africa.Frontiers in psychiatry · 2026Pooled it
- Tools for screening maternal mental health conditions in primary care settings in sub-Saharan Africa: systematic review.Frontiers in public health · 2024Pooled it
- Psychometric Validation of a Combined Assessment for Anxiety and Depression in Primary Care in Mozambique (CAD-MZ).Assessment · 2022Pooled it
- Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample.PloS one · 2022Trial
- Predictors of psychiatric emergency department visits within twelve months post-inpatient psychiatric discharge in Alberta, Canada.PloS one · 2026Observational
- Interconnected Challenges: Examining the Impact of Poverty, Disability, and Mental Health on Refugees and Host Communities in Northern Mozambique.Healthcare (Basel, Switzerland) · 2025Article
- Development of a Recommendation Engine to University Student Mental Health Support Aligned With Stepped Care: Longitudinal Cohort Study.Journal of medical Internet research · 2025Article
- Mental, physical, and respiratory health in people with tuberculosis in Southern Africa: a multi-country cohort analysis.BMC medicine · 2025Article
- Mental health and help-seeking behaviors among Mozambican youth: insights from a post-pandemic National Survey Amidst Internal Conflict.Social psychiatry and psychiatric epidemiology · 2025Article
- Article
- Supporting the mental health of adolescent mothers in Kenya and Mozambique: pilot protocol for the Thriving Mamas programme.Pilot and feasibility studies · 2025Article
- The impact of an integrated nurturing care intervention to improve early childhood development outcomes in Nampula Province, Mozambique.Public health nutrition · 2025Article
- Charting the course of depression care: a meta-analysis of reliability generalization of the patient health questionnaire (PHQ- 9) as the measure.Discover mental health · 2025Article
- Article
- Current state of mental health and substance use in Toledo, Belize: A mixed methods study.Global mental health (Cambridge, England) · 2025Article
- Factorial invariance of the Spanish version of the PHQ-9 by gender and country in Latin America and the Caribbean.Frontiers in psychiatry · 2025Article
- Mental health care cascade performance and associated factors: longitudinal analyses of routine Ministry of Health services in Mozambique.BMJ public health · 2025Article
- Psychometric Evaluation of Screens for Common Mental Disorders, Severe Mental Disorders, Substance Use Disorders, and Suicide Risk in Mozambican Healthcare.Medical research archives · 2024Article
- Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study.Frontiers in public health · 2024Article
- Article
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Authors and funding
8 authors at 6 institutions in 3 countries.
Funding
Abstract
backgroundDepression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique.
methodsThe PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool.
resultsThe majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach's alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%.
conclusionsThe PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.
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