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    PHQ-9 (Patient Health Questionnaire-9)

    Objectifies degree of depression severity.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Use as a screening tool:

    • To assist the clinician in making the diagnosis of depression.
    • To quantify depression symptoms and monitor severity.
    • The Patient Health Questionnaire (PHQ)-9 is the Major Depressive Disorder (MDD) module of the full PHQ.
    • Used to provisionally diagnose depression and grade severity of symptoms in general medical and mental health settings.
    • Scores each of the 9 DSM criteria of MDD as “0” (not at all) to “3” (nearly every day), providing a 0-27 severity score.
    • 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 score, but is a good indicator of the patient’s global impairment and can be used to track treatment response.
    • Higher PHQ-9 scores are associated with decreased functional status and increased symptom-related difficulties, sick days and healthcare utilization.

    Objectively determine initial symptoms severity and monitor symptom changes/effect of treatment over time.

    Over the last 2 weeks, how often have you been bothered by any of the following problems?
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    Not at all
    0
    Several days
    +1
    More than half the days
    +2
    Nearly every day
    +3
    If any of the above were scored more than “Not at all”:
    Not at all
    0
    Somewhat difficult
    +1
    Very difficult
    +2
    Extremely difficult
    +3
    About the Creator
    Dr. Kurt Kroenke
    Content Contributors

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Final diagnosis should be made with clinical interview and mental status examination including assessment of patient’s level of distress and functional impairment.

    Management

    PHQ-9 Management Summary

    Score Depression severity Comments
    0-4 Minimal or none Monitor; may not require treatment
    5-9 Mild Use clinical judgment (symptom duration, functional impairment) to determine necessity of treatment
    10-14 Moderate
    15-19 Moderately severe Warrants active treatment with psychotherapy, medications, or combination
    20-27 Severe

    Critical Actions

    • Perform suicide risk assessment in patients who respond positively to item 9 “Thoughts that you would be better off dead or of hurting yourself in some way.”
    • Rule out bipolar disorder, normal bereavement, and medical disorders causing depression.

    Formula

    Addition of the selected points.

    Facts & Figures

    The PHQ-9 is a validated, 9-question tool to assess for the degree of depression present in an individual; the last question is not scored, but is useful functionally to help the clinician assess the impact of the patient's symptoms on his or her life.

    Evidence Appraisal

    • PHQ-9 score of ≥10 has a sensitivity of 88% and a specificity of 88% in detecting MDD.
    • Criterion and construct validity of the scale was assessed in 3,000 primary care patients and replicated in 3,000 obstetrics-gynecology patients.
    Dr. Kurt Kroenke

    About the Creator

    Kurt Kroenke, MD, is a professor of medicine at the Indiana University School of Medicine and Director of the Career Development, Education and Research Training (CERT) program for the Indiana Clinical and Translational Sciences Institute (CTSI). He has won numerous grants for his research in pain, depression, and anxiety. He has over 300 peer-reviewed research publications.

    To view Dr. Kurt Kroenke's publications, visit PubMed

    Content Contributors