Original Study Testing the PHQ-9 Interview and Observational Versions (PHQ-9 OV) for MDS 3.0 Debra Saliba MD, MPH a, *, Suzanne DiFilippo RN, CCRC b , Maria Orlando Edelen PhD c , Kurt Kroenke MD d , Joan Buchanan PhD e , Joel Streim MD f a UCLA/Jewish Home Borun Center for Gerontological Research, Los Angeles, CA; Greater Los Angeles VA GRECC and HSR&D Center of Excellence; RAND, Santa Monica, CA b Veterans Integrated Service Network 4, Mental Illness Research Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA; Geriatric Psychiatry Section, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA c RAND, Boston, MA d Center for Implementing Evidence-Based Practice, Richard Roudebush VA Medical Center, Indianapolis, IN e Department of Health Care Policy (retired) Harvard Medical School, Boston, MA f Geriatric Psychiatry Section, Perelman School of Medicine at the University of Pennsylvania; VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA Keywords: Mood nursing home assessment Minimum Data Set depression observation interview PHQ-9 abstract Objectives: To test the feasibility and validity of the Patient Health Questionnaire-9 item interview (PHQ- 9) and the newly developed Patient Health Questionnaire Observational Version (PHQ-9 OV) for screening for mood disorder in nursing home populations. Methods: The PHQ-9 was tested as part of the national Minimum Data Set 3.0 (MDS 3.0) evaluation study among 3822 residents scheduled for MDS 2.0 assessments. Residents from 71 community nursing homes (NHs) in eight states were randomly included in a feasibility sample (n ¼ 3258) and a validation sample (n ¼ 418). Each resident’s ability to communicate determined whether the PHQ-9 interview or the PHQ-9 OV was initially attempted. In the validation sample, trained research nurses administered the instru- ments. For residents in the validation sample without severe cognitive impairment (3 MS 30) agree- ment between PHQ-9 and the modified Schedule for Affective Disorders and Schizophrenia (m-SADS) was measured with weighted kappas (k). For residents with severe cognitive impairment (3MS <30), agreement between PHQ-9 interview or PHQ-9 OV and the Cornell Scale for Depression in Dementia (Cornell Scale) was measured using correlation coefficients. Staff impressions were obtained from an anonymous survey mailed to all MDS assessors. Results: The PHQ-9 was completed in 86% of the 3258 residents in the feasibility sample. In the vali- dation sample, the agreement between PHQ-9 and m-SADS was very good (weighted k ¼ 0.69, 95% CI ¼ 0.61e0.76), whereas agreement between MDS 2.0 and m-SADS was poor (weighted k ¼ 0.15, 95% CI ¼ 0.06e0.25). Likewise, in residents with severe cognitive impairment, PHQ correlations with the criterion standard Cornell Scale were superior to the MDS 2.0 for both the PHQ-9 (0.63 vs 0.34) and the PHQ-9 OV (0.84 vs 0.28). Eighty-six percent of survey respondents reported that the PHQ-9 provided new insight into residents’ mood. The average time for completing the PHQ-9 interview was 4 minutes. Discussion: Compared with the MDS 2.0 observational items, the PHQ-9 interview had greater agreement with criterion standard diagnostic assessments. For residents who could not complete the interview, the PHQ-9 OV also had greater agreement with a criterion measure for depression than did the MDS 2.0 observational items. Moreover, the majority of NH residents were able to complete the PHQ-9, and most surveyed staff reported improved assessments with the new approach. Published by Elsevier Inc. on behalf of the American Medical Directors Association, Inc. This work was funded by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (HSR&D) Service (Project SDR 03-217), the Centers for Medicare & Medicaid Services and the UCLA/JH Borun Center. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the Centers for Medicare and Medicaid Services. * Address correspondence to Debra Saliba, MD, MPH, UCLA Borun Center for Gerontological Research, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095. E-mail address: saliba@rand.org (D. Saliba). JAMDA journal homepage: www.jamda.com 1525-8610/$ - see front matter Published by Elsevier Inc. on behalf of the American Medical Directors Association, Inc. http://dx.doi.org/10.1016/j.jamda.2012.06.003 JAMDA 13 (2012) 618e625