Patient Health Questionnaire-9 (PHQ-9) Adult
10 - item assessment tool for screening, diagnosing, monitoring and measuring the severity of depression.
Provided by
ISSWSHQuestions
Over the last 2 weeks, how often have you been bothered by any of the following problems?
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 10-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 9 questions will answer with one of the following:
| Answer | Points |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| Result | Recommendation | Score |
| Level of depressive symptoms: None (Score 0-4 pts) | Support & Monitoring | < 5 points |
| Level of depressive symptoms: Mild Depression |
| 5-9 points |
| Level of depressive symptoms: Moderate Depression |
| 10-14 points |
| Level of depressive symptoms: Moderately Severe Depression |
| 15-19 points |
| Level of depressive symptoms: Severe Depression |
| 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
- Blood sugar dysregulation and obesity (Lee, 2016; Calkin, 2019)
- Infection: A few examples -
- Lyme disease (Bransfield, 2018)
- Toxoplasma gondii (Hsu, 2014)
- Sedentary lifestyle (Stancykiewicz, 2019)
- Sleep deprivation and artificial light exposure (Figueiro, 2011; Gooley, 2011)
- Social isolation (Uchino, 2006; Cacioppo, 2002)
- Environmental exposure (A few examples)
- Indoor mold exposure (Ratnaseelan, 2018; Doi, 2011)
- Dietary triggers: Consider mold sensitivity from food or the environment. Foods such as coffee, peanuts and grains can have high levels of mold. Many other food sensitivities or allergies can also play a role. A food journal and an elimination diet may help sort this out.
- Autoimmune Disorders
- Stress
Therapeutic modalities that may reduce depression-related symptoms include:
- Psychotherapy
- Cognitive behavioral therapy
- Somatic experiencing therapy
- Eye Movement Desensitization and Reprocessing (EMDR)
- Vagus nerve stimulation
- Relaxation therapies
- Meditation
- Mindfulness-based stress reduction and breathing techniques
- Yoga
- Complementary and alternative medicine
- Acupuncture
- Massage
- Sound therapy
- Aromatherapy
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All questions & possible results
Questions
Over the last 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things?
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
2. Feeling down, depressed, or hopeless?
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
3. 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
4. Feeling tired or having little energy?
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
5. Poor appetite or overeating?
Select one option:
- Not at all
- Several days
- More than half the days
- Nearly every day
6. 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
7. 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
8. 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
9. 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
10. 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
Level of depressive symptoms: Mild Depression (Score 5-9 pts)
Please discuss with your health care provider. Further assessment may still be needed depending on your clinical presentation.
Medical Disclaimer & Terms of Use
- This assessment is for educational and informational purposes only. It is not a diagnostic tool and does not constitute medical advice, a professional diagnosis, an opinion, or a plan of treatment.
- Consult Your Doctor: The results of this electronic assessment are intended to be a starting point for a conversation with a qualified healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
- No Doctor-Patient Relationship: Use of this electronic tool does not create a doctor-patient relationship between you and the developers of this assessment. If you are experiencing a medical emergency, please stop and call your local emergency services or go to the nearest emergency room immediately.
- Accuracy of Data: By using this tool, you acknowledge that self-reported data is subjective. While this assessment utilizes validated scoring logic (such as the FSFI or DSDS), the interpretation of these scores requires clinical context that can only be provided by a licensed medical provider.
Level of depressive symptoms: Moderately Severe Depression (Score 15-19)
Please discuss with your health care provider. Further assessment may still be needed depending on your clinical presentation.
Medical Disclaimer & Terms of Use
- This assessment is for educational and informational purposes only. It is not a diagnostic tool and does not constitute medical advice, a professional diagnosis, an opinion, or a plan of treatment.
- Consult Your Doctor: The results of this electronic assessment are intended to be a starting point for a conversation with a qualified healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
- No Doctor-Patient Relationship: Use of this electronic tool does not create a doctor-patient relationship between you and the developers of this assessment. If you are experiencing a medical emergency, please stop and call your local emergency services or go to the nearest emergency room immediately.
- Accuracy of Data: By using this tool, you acknowledge that self-reported data is subjective. While this assessment utilizes validated scoring logic (such as the FSFI or DSDS), the interpretation of these scores requires clinical context that can only be provided by a licensed medical provider.
Level of depressive symptoms: Severe Depression (Score 20-27)
Please discuss with your health care provider. Further assessment may still be needed depending on your clinical presentation.
Medical Disclaimer & Terms of Use
- This assessment is for educational and informational purposes only. It is not a diagnostic tool and does not constitute medical advice, a professional diagnosis, an opinion, or a plan of treatment.
- Consult Your Doctor: The results of this electronic assessment are intended to be a starting point for a conversation with a qualified healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
- No Doctor-Patient Relationship: Use of this electronic tool does not create a doctor-patient relationship between you and the developers of this assessment. If you are experiencing a medical emergency, please stop and call your local emergency services or go to the nearest emergency room immediately.
- Accuracy of Data: By using this tool, you acknowledge that self-reported data is subjective. While this assessment utilizes validated scoring logic (such as the FSFI or DSDS), the interpretation of these scores requires clinical context that can only be provided by a licensed medical provider.
Level of depressive symptoms: None (Score 0-4 pts).
Please discuss with your health care provider. Further assessment may still be needed depending on your clinical presentation.
Medical Disclaimer & Terms of Use
- This assessment is for educational and informational purposes only. It is not a diagnostic tool and does not constitute medical advice, a professional diagnosis, an opinion, or a plan of treatment.
- Consult Your Doctor: The results of this electronic assessment are intended to be a starting point for a conversation with a qualified healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
- No Doctor-Patient Relationship: Use of this electronic tool does not create a doctor-patient relationship between you and the developers of this assessment. If you are experiencing a medical emergency, please stop and call your local emergency services or go to the nearest emergency room immediately.
- Accuracy of Data: By using this tool, you acknowledge that self-reported data is subjective. While this assessment utilizes validated scoring logic (such as the FSFI or DSDS), the interpretation of these scores requires clinical context that can only be provided by a licensed medical provider.
WARNING: The patient is having thoughts of suicidal ideation or self-harm.
Important Notice Regarding Your Response
- You indicated that you have been having thoughts of self-harm or that you would be better off dead.
- Please know that you are not alone, and help is available right now.
Because your safety is the most important thing, please take one of the following steps immediately:
- Call, Text or Chat to reach the Suicide & Crisis Lifeline (available 24/7): Visit 988lifeline.org
- Call 911 or go to the nearest Emergency Room if you feel you are in immediate danger.
- Please reach out to your primary healthcare provider or a mental health professional as soon as possible to discuss these feelings further.
Level of depressive symptoms: Moderate Depression (score 10-14)
Please discuss with your health care provider. Further assessment may still be needed depending on your clinical presentation.
Medical Disclaimer & Terms of Use
- This assessment is for educational and informational purposes only. It is not a diagnostic tool and does not constitute medical advice, a professional diagnosis, an opinion, or a plan of treatment.
- Consult Your Doctor: The results of this electronic assessment are intended to be a starting point for a conversation with a qualified healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
- No Doctor-Patient Relationship: Use of this electronic tool does not create a doctor-patient relationship between you and the developers of this assessment. If you are experiencing a medical emergency, please stop and call your local emergency services or go to the nearest emergency room immediately.
- Accuracy of Data: By using this tool, you acknowledge that self-reported data is subjective. While this assessment utilizes validated scoring logic (such as the FSFI or DSDS), the interpretation of these scores requires clinical context that can only be provided by a licensed medical provider.
Citation
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
PHQ-9 is courtesy of Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission is required to reproduce, translate, display or distribute.
Literature
- The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. — Kroenke K, Spitzer RL, Williams JB.
- Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010 Jul-Aug;8(4):348-53. — Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S.
- Depression: Screening and Diagnosis. Am Fam Physician. 2018 Oct 15;98(8):508-515. — Maurer DM, Raymond TJ, Davis BN.
- Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019 Apr 9;365:l1476. — Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration.
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