Detecting Somatoform Disorders in Primary Care With the PHQ-15

1. Hiske van Ravesteijn, MD1,2,
2. Karin Wittkampf, MD3,
3. Peter Lucassen, MD, PhD1,
4. Eloy van de Lisdonk, MD, PhD1,
5. Henk van den Hoogen, MSc1,
6. Henk van Weert, MD, PhD3,
7. Jochanan Huijser, MD, PhD4,
8. Aart Schene, MD, PhD4,
9. Chris van Weel, MD, PhD1 and
10. Anne Speckens, MD, PhD2

+ Author Affiliations

1. ¹Department of Primary and Community Care, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
2. ²Department of Psychiatry, Radboud University, Nijmegen Medical Center, Nijme-gen, The Netherlands
3. ³Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
4. ⁴Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

1. CORRESPONDING AUTHOR: Hiske van Ravesteijn, MD, Department of Primary and Community Care, Radboud University, Nijmegen Medical Centre, PO Box 9101, 6500 MB, Nijmegen, The Netherlands., h.vanravesteijn@hag.umcn.nl

Abstract

PURPOSE 

Because recognition and management of patients with somatoform disorders are difficult, we wanted to determine the specificity, sensitivity, and the test-retest reliability of the 15-symptom Patient Health Questionnaire (PHQ-15) for detection of somatoform disorders in a high-risk primary care population. 

METHODS 

We studied the performance of the PHQ-15 in comparison with the Structured Clinical Interview for the Diagnostic and Statistical Manual-IV Axis I disorders (SCID-I) as a reference standard. From January through September 2006, we approached patients for participation. This study was conducted in primary care settings in the Netherlands. Patients aged between 18 and 70 years were eligible if they belonged to 1 or more of the following groups: (1) patients with unexplained somatic complaints, (2) frequent attenders, and (3) patients with mental health problems. For the SCID-I interview we invited all patients with a PHQ-15 score of 6 or greater and a random sample of 30% of patients with a PHQ-15 score of less than 6. The primary study outcomes were the sensitivity and specificity for the validity and the κ coefficient for the test-retest reliability. 

RESULTS 

Of 2,147 eligible patients, 906 (42%) participated (mean age 48 years, 62% female). At a cutoff level of 3 or more severe somatic symptoms during the past 4 weeks, sensitivity was 78% and specificity 71%. The test-retest reliability was 0.60. 

CONCLUSIONS 

The PHQ-15 is a valid and moderately reliable questionnaire for the detection of patients in a primary care setting at risk for somatoform disorders.

Key Words:

• Somatoform disorders/diagnosis
• mental health
• somatization

• Received for publication March 12, 2008.
• Revision received July 4, 2008.
• Accepted for publication August 25, 2008.