Using the PHQ-9 to diagnosis depression

The Patient Health Questionnaire is a depression questionnaire that can be used to make a diagnosis of depression and rate the severity. If medicine or psychotherapy is prescribed it can be used to follow a person’s response to the treatment. It is the instrument recommended by the MacArthur Initiative on Depression and Primary Care at www.depression-primarycare.org.

Patient Health Questionnaire (PHQ-9)

Over the last two weeks, how often have you been bothered by any of the following problems?
(Circle the response that applies)

1. Little interest or pleasure in doing things
       
            Not at all        Several Days        More Than Half The Days        Nearly Every Day

2. Feeling down, depressed, or hopeless

            Not at all        Several Days        More Than Half The Days        Nearly Every Day

3. Trouble falling or staying asleep, or sleeping too much

            Not at all        Several Days        More Than Half The Days        Nearly Every Day

4. Feeling tired or having little energy

            Not at all        Several Days        More Than Half The Days        Nearly Every Day

5. Poor appetite or overeating

            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

            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

            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 the opposite—    being so fidgety or restless that you have been moving around a lot more than usual

            Not at all        Several Days        More Than Half The Days        Nearly Every Day

9. Thoughts that you would be better off dead, or of hurting yourself in some way

            Not at all        Several Days        More Than Half The Days        Nearly Every Day

10. If you checked off any problems (Items 1 thru 9) 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

            Not difficult at all        Somewhat difficult        Very difficult        Extremely difficult

Scoring the PHQ-9

“A depression diagnosis that warrants treatment or treatment change, needs at least one of the first two questions endorsed as positive (little pleasure, feeling depressed) indicating the symptom has been present more than half the time in the last two weeks.

“In addition, the tenth question, about difficulty at work or home or getting along with others should be answered at least ‘somewhat difficult.'”

There are sample PHQ-9 forms that show how to do the scoring at  http://www.depression-primarycare.org/images/pdf/phq_9_eng.pdf

Once you have your PHQ-9 score, this is what it means:

A score of 5 to 9 means minimal symptoms. Basically just recheck periodically.

A score of 10 to 14 means minor depression, dysthmia, or mild major depression. Support or watchful waiting is appropriate for a minor depression. If the diagnosis is dysthymia or mild major depression, then psychotherapy or antidepressants are indicated.

A score of 15 to 19 means a provisional diagnosis of major depression, moderately severe and antidepressant or psychotherapy is indicated.

A score of 20 or greater means severe major depression and is an indication for both antidepressant and psychotherapy.

In the next post I’ll talk about choosing an antidepressant to get started on your treatment.

 

 

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