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Patient Health Questionnaire-9 - Adult (PHQ-9)

Multipurpose assessment tool for screening, diagnosing, monitoring and measuring the severity of depression.

Jennifer Glen

Provided by EVAL Foundation
Play
Instructions

 

The PHQ-9 is a screening tool used by health practitioners to determine initial symptom severity and monitor effect of treatment over time and does not replace a clinical assessment and diagnosis.

 

Ask: How often do you feel bothered by the following over the past 2 weeks?

0%
Usage

Major Depressive Disorder (MDD) is one of the most common mental health disorders in the United States (Maurer, Raymond & Davis, 2018). The Patient Health Questionnaire-9 (PHQ-9) is a 9-item validated screening tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant depressive disorder. The PHQ-9 can assist clinicians in making a diagnosis of depression, quantifying depression symptoms, and monitoring severity and treatment efficacy. Higher scores are associated with decreased functional status and symptom-related difficulties. 

 

However, the PHQ-9 is prone to high false-positive rates in primary care settings with one meta-analysis found that only 50% of patients screening positive actually has major depression (Levis et al., 2019). Therefore, when screening for possible depression, the diagnosis ought to be confirmed using DSM-5 criteria. Maurer et al. (2018) summarizes the use of the PHQ-9 as a screening tool and its relationship to the DSM-5 diagnostic criteria for Major Depressive Disorder. Further, root causes and other mental health disorders ought to be considered. PHQ-9 scores > 9 had a sensitivity and specificity of 88% for major depression. A tip sheet highlights additional criteria when using the PHQ-9 to make a tentative depression diagnosis. 

 

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Summary

The Patient Health Questionnaire-9 (PHQ-9) is a 9-item validated screening tool and a symptom severity assessment scale that assists clinicians, typically primary care and mental health settings, with rapid screening for the presence of a clinically significant depressive disorder. Higher scores are associated with decreased functional status and symptom-related difficulties. The last item, How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people, is not included in the score, but is a good indicator of the patient’s global impairment and can be used to track treatment response.

 

Scoring & Recommendations

 

The first 7 questions will answer with one of the following:

 

AnswerPoints
Not at all0
Several days1
More than half the days2
Nearly every day3

 

 

Result RecommendationScore
Level of depressive symptoms: None (Score 0-4 pts)Support & Monitoring< 5 points
Level of depressive symptoms: Mild Depression
  1. Consider further evaluation for possible clinically significant condition.
  2. Consider symptom duration and functional impairment to determine treatment strategies.
5-9 points
Level of depressive symptoms: Moderate Depression
  1. Consider further evaluation for possible clinically significant condition.
  2. Consider symptom duration and functional impairment to determine treatment strategies
10-14 points
Level of depressive symptoms: Moderately Severe Depression
  1. Consider further evaluation for possible clinically significant condition.
  2. Consider symptom duration and functional impairment to determine treatment strategies
  3. May warrant psychotherapy or antidepressant  
15-19 points
Level of depressive symptoms: Severe Depression 
  1. Consider further evaluation for possible clinically significant condition.
  2. Consider symptom duration and functional impairment to determine treatment strategies
  3. May warrant psychotherapy and antidepressant  
20-27 points

 

 

Additional Considerations

 

PHQ-9 scores > 9 had a sensitivity and specificity of 88% for major depression. A tip sheet highlights additional criteria when using the PHQ-9 to make a tentative depression diagnosis. However, when screening for possible depression, the diagnosis ought to be confirmed using DSM-5 criteria. Maurer et al. (2018) summarizes the use of the PHQ-9 as a screening tool and its relationship to the DSM-5 diagnostic criteria for Major Depressive Disorder. Further, root causes and other mental health disorders ought to be considered. 

 

Management

 

The clinician ought to rule out physical causes of symptoms, normal bereavement, stress, chronic illness and a history of a manic/hypomanic episode.

 

Some possible root causes of depression

 

Therapeutic modalities that may reduce depression-related symptoms include:

 

 

  • Complementary and alternative medicine
    • Acupuncture
    • Massage
    • Sound therapy
    • Aromatherapy
.

All questions & possible results

InstructionsTitle not visible
Little interest or pleasure in doing things?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Feeling down, depressed, or hopeless?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Trouble falling or staying asleep, or sleeping too much?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Feeling tired or having little energy?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Poor appetite or overeating?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Feeling bad about yourself -- or that you are a failure or have let yourself or your family down?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
How difficult have these problems made it to do work, take care of things at home, or get along with other people?

Select one option:

  • Not at all
  • Somewhat difficult
  • Very difficult
  • Extremely difficult
Possible results
Functionally, the patients finds it "somewhat difficult" to perform tasks due to their symptoms.
Level of depressive symptoms: Moderately Severe Depression (Score 15-19)

PHQ-9 scores > 9 had a sensitivity and specificity of 88% for major depression. A tip sheet highlights additional criteria when using the PHQ-9 to make a tentative depression diagnosis.  However, when screening for possible depression, the diagnosis ought to be confirmed using DSM-5 criteria. Maurer et al. (2018) summarizes the use of the PHQ-9 as a screening tool and its relationship to the DSM-5 diagnostic criteria for Major Depressive Disorder. Further, root causes and other mental health disorders ought to be considered. 

 

Management

  1. The clinician ought to rule out physical causes of symptoms, normal bereavement, stress, chronic illness and a history of a manic/hypomanic episode. 
  2. Consider further evaluation for possible clinically significant condition.
  3. Consider symptom duration and functional impairment to determine treatment strategies.
  4. May warrant psychotherapy or antidepressant  
  5. Educate to call if symptoms change, worsen or persist

 

 

Some possible root causes of depression

 

Therapeutic modalities that may reduce depression-related symptoms include:

 

 

  • Complementary and alternative medicine
    • Acupuncture
    • Massage
    • Sound therapy
    • Aromatherapy
WARNING: The patient is having thoughts of suicidal ideation or self-harm.

Perform suicide risk assessment.

Level of depressive symptoms: None (Score 0-4 pts).

Management

  • The clinician ought to rule out physical causes of symptoms, normal bereavement, stress, chronic illness and a history of a manic/hypomanic episode.
  • Consider the following
    1. Support & Monitoring
    2. Educate to call if symptoms change, worsen or persist

 

Some possible root causes of depression

Level of depressive symptoms: Mild Depression (Score 5-9 pts)

When screening for possible depression, the diagnosis ought to be confirmed using DSM-5 criteria. Maurer et al. (2018) summarizes the use of the PHQ-9 as a screening tool and its relationship to the DSM-5 diagnostic criteria for Major Depressive Disorder. Further, root causes and other mental health disorders ought to be considered.

 

Management

  1. The clinician ought to rule out physical causes of symptoms, normal bereavement, stress, chronic illness and a history of a manic/hypomanic episode. 
  2. Consider further evaluation for possible clinically significant condition.
  3. Consider symptom duration and functional impairment to determine treatment strategies.
  4. Educate to call if symptoms change, worsen or persist

 

Some possible root causes of depression

 

Therapeutic modalities that may reduce depression-related symptoms include:

 

 

  • Complementary and alternative medicine
    • Acupuncture
    • Massage
    • Sound therapy
    • Aromatherapy
Level of depressive symptoms: Severe Depression (Score 20-27)

PHQ-9 scores > 9 had a sensitivity and specificity of 88% for major depression. A tip sheet highlights additional criteria when using the PHQ-9 to make a tentative depression diagnosis. However, when screening for possible depression, the diagnosis ought to be confirmed using DSM-5 criteria. Maurer et al. (2018) summarizes the use of the PHQ-9 as a screening tool and its relationship to the DSM-5 diagnostic criteria for Major Depressive Disorder. Further, root causes and other mental health disorders ought to be considered. 

 

Management

  1. The clinician ought to rule out physical causes of symptoms, normal bereavement, stress, chronic illness and a history of a manic/hypomanic episode. 
  2. Consider further evaluation for possible clinically significant condition.
  3. Consider symptom duration and functional impairment to determine treatment strategies.
  4. May warrant psychotherapy and antidepressant  
  5. Educate to call if symptoms change, worsen or persist

 

Some possible root causes of depression

 

Therapeutic modalities that may reduce depression-related symptoms include:

 

 

  • Complementary and alternative medicine
    • Acupuncture
    • Massage
    • Sound therapy
    • Aromatherapy
Level of depressive symptoms: Moderate Depression (score 10-14)

PHQ-9 scores > 9 had a sensitivity and specificity of 88% for major depression. A tip sheet highlights additional criteria when using the PHQ-9 to make a tentative depression diagnosis. However, when screening for possible depression, the diagnosis ought to be confirmed using DSM-5 criteria. Maurer et al. (2018) summarizes the use of the PHQ-9 as a screening tool and its relationship to the DSM-5 diagnostic criteria for Major Depressive Disorder. Further, root causes and other mental health disorders ought to be considered. 

 

Management

  1. The clinician ought to rule out physical causes of symptoms, normal bereavement, stress, chronic illness and a history of a manic/hypomanic episode. 
  2. Consider further evaluation for possible clinically significant condition.
  3. Consider symptom duration and functional impairment to determine treatment strategies.
  4. Educate to call if symptoms change, worsen or persist

 

Some possible root causes of depression

 

Therapeutic modalities that may reduce depression-related symptoms include:

 

 

  • Complementary and alternative medicine
    • Acupuncture
    • Massage
    • Sound therapy
    • Aromatherapy
Functionally, the patients finds it "very difficult" to perform tasks due to their symptoms.
Functionally, the patients finds it "extremely difficult" to perform tasks due to their symptoms.

Literature

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