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I am planning a study of an online intervention for depression in India. We were planning to use Patient Health Questionnaire-9 (PHQ-9) for assessing the depression symptom severity. One of our collaborators raised an important question in a recent meeting. He asked what is the validity of PHQ-9 in India and is there a possibility of using any other tool that is more valid?

I have searched the web and found some studies that have used PHQ-9 in adult (another study) as well as adolescent populations in India. I also found a paper that developed a slightly modified version of PHQ-9, called PHQ-12, for an Indian population.

I just wanted to know if there is any other tool that has been developed specifically for an Indian population or even any tool that has been well validated for an Indian population.

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    $\begingroup$ Thanks for the question! Can you please provide some references to what you are discussing (specifically your papers)? Just my 2 cents, but if you have a version of the tool specifically modified for an Indian population (and a publication on the validity and process), you probably aren't going to get much better than that ... What else would you demand of an instrument to be valid for your population? $\endgroup$ – mfloren Aug 24 '17 at 14:24
  • $\begingroup$ @mfloren I have added links to the relevant papers. PHQ-9 has been validated and used in many studies worldwide as well as in India. Whereas, the tool, PHQ-12, has only been used in two studies and the Journals are not peer-reviewed. So, I was a little skeptic of its acceptability to the international community. That is why I was trying to find out if there is anything that has been better validated. $\endgroup$ – Arka Ghosh Aug 25 '17 at 6:09
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I am sharing my research here should anybody find it useful.

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Although PHQ-9 wasn’t developed for an Indian audience, it has been used by multiple studies in India [1, 2, 3]. It has also been validated for an adolescent population, and a score of was found to have high sensitivity (87.1%) and specificity (79.7%) [4]. A modified version of PHQ-9, the PHQ-12, was developed and validated on a South Indian population of 100 participants. PHQ-12 essentially tests the same symptoms as PHQ-9 but differs in number of questions, the specific wordings of the questions, and the marking scheme. PHQ-12 lets the patient mark every question in a ‘Yes’ or ‘No’. A ‘Yes’ is given a score of 1 and a ‘No’ a score of 0. A total score of >4 according to this

marking scheme has shown the highest sensitivity (92.0%) and specificity (90.7%) when compared against PHQ-9 [5]. Other popular scales for diagnosis of depression - Hamilton Depression Rating Scale, Beck Depression Inventory, and Montogomery Asberg Depression Rating Scale - have been adapted for an Indian population [6, 7, 8]. Brief Patient Health Questionnaire has also been translated into 11 Indian languages and validated for an Indian population [9]. A novel scale, Amritsar Depressive Inventory (ADI), has been developed based on symptoms which are more prevalent in Indian populations [10].

  1. Mehrotra, Seema, et al. "Profile of seekers of an internet-based self-help program for depression in India: observations and implications." International Journal Of Community Medicine And Public Health (2017).
  2. Sidana, Surbhi, et al. "Prevalence of depression in students of a medical college in New Delhi: a cross-sectional study." The Australasian medical journal 5.5 (2012): 247.
  3. Thour, Amit, et al. "Depression among patients with diabetes mellitus in North India evaluated using patient health questionnaire-9." Indian journal of endocrinology and metabolism 19.2 (2015): 252.
  4. Ganguly, Samrat, et al. "Patient health questionnaire-9 as an effective tool for screening of depression among Indian adolescents." Journal of Adolescent Health 52.5 (2013): 546-551.
  5. Poongothai, S., et al. "Reliability and validity of a modified PHQ-9 item inventory (PHQ-12) as a screening instrument for assessing depression in Asian Indians (CURES-65)." (2009).
  6. Ajmany S, Nandi DN. Adaptation of A. T. Beck et al.'s "an inventory for measuring depression" Indian J Psychiatry 1973;15:386-90.
  7. Ganguli M, Dube S, Johnston JM, Pandav R, Chandra V, Dodge HH. Depressive symptoms, cognitive impairment and functional impairment in a rural elderly population in India: A Hindi version of the geriatric depression scale (GDS-H). Int J Geriatr Psychiatry 1999;14:807-20.
  8. Raguram R, Weiss MG, Channabasavanna SM, Devms GM. Stigma, depression, and somatization in south India. Am J Psychiatry 1996;1531043-9.
  9. Kochhar, P. H., S. S. Rajadhyaksha, and V. R. Suvarna. "Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients." Journal of postgraduate medicine 53.2 (2007): 102.
  10. Grover, Sandeep, Alakananda Dutt, and Ajit Avasthi. "An overview of Indian research in depression." Indian journal of psychiatry 52.Suppl1 (2010): S178.
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  • $\begingroup$ Excellent stuff Arka! Thank you for sharing your own research :) $\endgroup$ – Robin Kramer Aug 27 '17 at 5:53

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