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PHQ-9 (Patient Health Questionnaire-9)

Degree of depression severity.

id

1725

full_title

PHQ-9 (Patient Health Questionnaire-9)

short_title

PHQ-9

med_description

Objectifies degree of depression severity.

description

The PHQ-9 (Patient Health Questionnaire-9) objectifies and assesses degree of depression severity via questionnaire.

keywords

Depression screening, depression screen, PHQ depression, PHQ-9 screen, PHQ depression diagnosis, depression questionnaire, PHQ calc, depression calc, depression objectify, depressive symptoms calc, depression symptoms calc, phq symptoms calc, phq sx, depressive sx calc, depression sx calc, phq screen, patient health questionnaire, patient depression questionnaire

complaint

[ "Depressed" ]

formula

Addition of the selected points.

evidence

The PHQ-9 was initially developed by Kroenke et al (2001), as a subset of 9 questions from the full PHQ, which had previously been derived and studied in a cohort of 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics (Spitzer 1999). PHQ-9 scores ≥10 were found to be 88% sensitive and also 88% specific for detecting MDD. Criterion validity was also assessed in a sample of 580 patients.

Arroll et al (2010) validated the PHQ-9 as a screener for MDD in a cohort of 2,642 primary care patients and found slightly higher specificity (91%) and lower sensitivity (74%) at the same cutoff of 10 points.

The PHQ-9 has also been validated in several additional subpopulations, including in psychiatric patients (Beard 2016), patients with medical comorbidities such as multiple sclerosis (Ferrando 2007) and Parkinson’s disease (Chagas 2013), pregnant patients (Sidebottom 2012), and in an occupational health setting (Volker 2016).

A meta-analysis of 29 studies including 6,725 patients found similar sensitivity (88%, 95% CI 83-92%) and specificity (85%, 95% CI 82-88%) for a cutoff of ≥10 as did the previous studies, both overall and for subgroups. Notably, they found that when used in the primary care setting, only approximately 50% of patients screening positive on the PHQ-9 in fact had major depression (Levis 2019).

measurements

[]

information

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.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/11556941", "text": "Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. PubMed PMID: 11556941; PubMed Central PMCID: PMC1495268." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/10568646", "text": "Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737-44." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/20644190", "text": "Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S. 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. doi: 10.1370/afm.1139. PubMed PMID: 20644190; PubMed Central PMCID: PMC2906530." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23761457", "text": "Chagas MH, Tumas V, Rodrigues GR, et al. Validation and internal consistency of Patient Health Questionnaire-9 for major depression in Parkinson's disease. Age Ageing. 2013;42(5):645-9." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/26377480", "text": "Volker D, Zijlstra-Vlasveld MC, Brouwers EP, et al. Validation of the Patient Health Questionnaire-9 for Major Depressive Disorder in the Occupational Health Setting. J Occup Rehabil. 2016;26(2):237-44." }, { "href": "https://meridian.allenpress.com/ijmsc/article/9/3/99/33342/Patient-Health-Questionnaire-9-to-Screen-for", "text": "Ferrando SJ, Samton J, Mor N, et al. Patient Health Questionnaire-9 to Screen for Depression in Outpatients With Multiple Sclerosis. International Journal of MS Care: 2007;9(3):99-103." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/26774513", "text": "Beard C, Hsu KJ, Rifkin LS, et al. Validation of the PHQ-9 in a psychiatric sample. J Affect Disord. 2016;193:267-73." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/22983357", "text": "Sidebottom AC, Harrison PA, Godecker A, Kim H. Validation of the Patient Health Questionnaire (PHQ)-9 for prenatal depression screening. Arch Womens Ment Health. 2012;15(5):367-74." }, { "href": "https://www.bmj.com/content/365/bmj.l1476", "text": "Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476." } ], "Validations": [] }

pearls

  • 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).

usecase

Use as a screening tool:

  • To assist the clinician in making the diagnosis of depression.
  • To quantify depression symptoms and monitor severity.

reasons

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

next_advice

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

next_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.

next_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

diseases

[ "Depression/Suicidality" ]

instructions

published

2022-04-21T20:28:58.623Z

purpose

[ "Diagnosis" ]

search_terms

[ "depression", "psych", "si", "suicidal", "phq9", "phq-9" ]

seo

{ "keywords_en": "Depression screening, depression screen, PHQ depression, PHQ-9 screen, PHQ depression diagnosis, depression questionnaire, PHQ calc, depression calc, depression objectify, depressive symptoms calc, depression symptoms calc, phq symptoms calc, phq sx, depressive sx calc, depression sx calc, phq screen, patient health questionnaire, patient depression questionnaire", "meta_description_en": "The PHQ-9 (Patient Health Questionnaire-9) objectifies and assesses degree of depression severity via questionnaire." }

specialty

[ "Family Practice", "Internal Medicine", "Primary Care", "Psychiatry" ]

departments

[ "Psychiatric" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1844, "short_title_en": "Major Depression Index", "slug": "major-depression-index-mdi" }, { "calcId": 1845, "short_title_en": "QIDS", "slug": "quick-inventory-depressive-symptomatology-qids" }, { "calcId": 10195, "short_title_en": "DSM-5 Criteria for Major Depressive Disorder", "slug": "dsm-5-criteria-major-depressive-disorder" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "psychiatry" ]

cleaned_use

[ "Use as a screening tool:", "To assist the clinician in making the diagnosis of depression.", "To quantify depression symptoms and monitor severity." ]

pub

true

<p><strong>Ask the patient:</strong> how often have they been bothered by the following over the past 2 weeks?</p>
<p>Little interest or pleasure in doing things?</p>
<p>Feeling down, depressed, or hopeless?</p>
<p>Trouble falling or staying asleep, or sleeping too much?</p>
<p>Feeling tired or having little energy?</p>
<p>Poor appetite or overeating?</p>
<p>Feeling bad about yourself &mdash; or that you are a failure or have let yourself or your family down?</p>
<p>Trouble concentrating on things, such as reading the newspaper or watching television?</p>
<p>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?</p>
<p>Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?</p>
<p>Ask the patient: how difficult have these problems made it to do work, take care of things at home, or get along with other people?</p>