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    PHQ-9 (Patient Health Questionnaire-9)

    Objectifies degree of depression severity.
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    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.
    • May have high false-positive rates in primary care settings specifically (one meta-analysis found that only 50% of patients screening positive actually had major depression) (Levis 2019).

    Objectively determines severity of initial symptoms, and also monitors symptom changes and treatment effects over time.

    Ask the patient: how often have they been bothered by the following over the past 2 weeks?
    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

    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.
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    Dr. Kurt Kroenke
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