Abstract
There is an increased need for efficient, low-cost methods to collect information on a range of widely prevalent mental health outcomes in the general population that can be administered outside of clinical settings. We evaluate the validity of a single-item Visual Analogue Scale (VAS) for assessing the presence and severity of depression and compare its performance with the Patient Health Questionnaire (PHQ-9) depression scale using a large non-clinical sample (N = 1816) of college students from Switzerland. The VAS scale is strongly correlated with the PHQ-9 total score (0.61) and its 9 individual items (ranging from 0.19 to 0.67). ROC analysis shows that the VAS scale has high accuracy for detecting the presence and different levels (mild to severe) of depression corresponding to PHQ-9 cutoffs. The VAS depression scale represents a simple, easily implementable instrument that is suitable for mental health research in common settings and larger population-based studies.
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Notes
Participants were students at the Swiss Federal Institute of Technology in Lausanne (EPFL), the University of Lausanne (UNIL) and Ecole hoteliere de Lausanne (EHL). In the beginning of each academic year, students from these three schools can register in the Laboratory of Behavioral Experiments at the University of Lausanne and participate in experiments and surveys, for which they are financially compensated.
In a rather similar setting, Garlow et al. (2008) invited about 9000 college students to participate in an online survey on mental health. Out of those invited, 729 college students completed the online questionnaire, which corresponds to a response rate of about 8.1%. Sax et al. (2003) invited a set of 733 first-year college students in the US to participate in an online survey with response incentive. A total of 125 observations was collected, which represents a response rate of about 17%.
The distribution of prizes was the following: three winners that made USD 300, 10 winners that earned USD 100 and 60 respondents who won USD 20.
The authors have no conflict of interest in any form and certify responsibility for this study.
Sensitivity analysis showed that the results are robust to the inclusion of those 122 observations. Results are available upon request.
We administered the official French for Switzerland version of the PHQ-9 available here https://www.phqscreeners.com/select-screener/ since Canton Vaud is French speaking.
See https://www.bfs.admin.ch, “Household income and expenditure” section for details.
Vignettes are hypothetical scenarios that describe the situation of a person. Because respondents are asked to evaluate identical situations and scenarios, vignettes’ evaluation can be used to identify the reporting scale of respondents and hence detect the presence of DIF. The vignettes we used in our study were adapted from WHO Study on Global Aging and Adult Health (SAGE) and tailored to a population of students. Each vignette consisted in two to three sentences that characterize the frequency of people feeling happy or depressed, how people think about the future, how people perceive their usefulness, whether people have suicidal thoughts, etc.
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Acknowledgements
The study was funded by the HEC Research Fund 2017 - University of Lausanne, Switzerland.
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The authors also confirm that the funding source (HEC Research Fund 2017 - University of Lausanne, Switzerland) has had no involvement in the design and conduct of the study, as well as in the data collection, management, analysis and interpretation of the data and the preparation of the manuscript. The funds have been used exclusively to incentivize the pool of students to participate in the online survey.
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Appendix: The PhQ-9 questionnaire
Appendix: The PhQ-9 questionnaire
Over the last 2 weeks, how often have you been bothered by any of the following problems? | Not at all | Several days | More than half the days | Nearly everyday |
|---|---|---|---|---|
1. Little interest or pleasure in doing things | 0 | 1 | 2 | 3 |
2. Feeling down, depressed, or hopeless | 0 | 1 | 2 | 3 |
3. Trouble falling or staying asleep, or sleeping too much | 0 | 1 | 2 | 3 |
4. Feeling tired or having little energy | 0 | 1 | 2 | 3 |
5. Poor appetite or overeating | 0 | 1 | 2 | 3 |
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down | 0 | 1 | 2 | 3 |
7. Trouble concentrating on things, such as reading the newspaper or watching television | 0 | 1 | 2 | 3 |
8. Moving or speaking so slowly that other people could have noticed? Or the opposite- being so fidgety or restless you that have been moving around a lot more than usual | 0 | 1 | 2 | 3 |
9. Thoughts that you would be better off dead or of hurting yourself in some way | 0 | 1 | 2 | 3 |
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Huang, Z., Kohler, I.V. & Kämpfen, F. A Single-Item Visual Analogue Scale (VAS) Measure for Assessing Depression Among College Students. Community Ment Health J 56, 355–367 (2020). https://doi.org/10.1007/s10597-019-00469-7
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DOI: https://doi.org/10.1007/s10597-019-00469-7