Patient Health Questionnaire

Original Editor - Manisha Shrestha Top Contributors - Manisha Shrestha and Cindy John-Chu

Original Editor - User Name

Top Contributors - Manisha Shrestha and Cindy John-Chu  

Introduction

Patient Health Questionnaire (PHQ)

• is a self-administered version of the PRIME-MD (Primary Care Evaluation of Mental Disorders) diagnostic instrument for common mental disorders.
• was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues.
• incorporate DSM-IV depression criteria with other leading major depressive symptoms into a brief self-report instruments that are commonly used for screening and diagnosis, as well as selecting and monitoring treatment.
• has two versions PHQ-9 and PHQ-2.

PHQ-9

• This depression module consists of 9 questions related to DSM-IV criteria.
• These questions are asked based on the past 2 weeks.
• It is a likert scale in which “0” (not at all) to “3” (nearly every day) so the maximum total score is 27 and minimum score is 0.
• with increase score signifies increase in severity.
• An item was also added to the end of the diagnostic portion of the PHQ-9 asking patients who checked off any problems on the questionnaire: “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?”
• It can be assessed here.

PHQ- 2

• It came into the picture as even briefer outcome measures is desirable for use in busy clinical settings or as part of comprehensive health questionnaires.
• The purpose of the PHQ-2 is to screen for depression in a “first-step” approach.
• Patients who screen positive should be further evaluated with the PHQ-9 to determine whether they meet criteria for a depressive disorder.
• It inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day").
• It can be assessed here.

Objective

The patient health questionnaire (PHQ) is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.

Intended Population

• General population with 15 years or older.

Method of Use

It is a self-report outcome measure.

Interpretation

The scores range from 0-27 where increase in the score denotes increase in the severity.

Total scores of 5, 10, 15, and 20 represent cut -points for mild, moderate, moderately severe and severe depression, respectively.

Note: Question 9 is a single screening question on suicide risk. A patient who answers yes to question 9 needs further assessment for suicide risk by an individual who is competent to assess this risk.

Provisional Diagnosis and Proposed Treatment Actions

PHQ-9 Score	Depression Severity	Proposed Treatment Actions
0 – 4	None-minimal	None
5 – 9	Mild	Watchful waiting; repeat PHQ-9 at follow-up
10 – 14	Moderate	Treatment plan, considering counseling, follow-up and/or pharmacotherapy
15 – 19	Moderately Severe	Active treatment with pharmacotherapy and/or psychotherapy
20 – 27	Severe	Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management

Psychometric Properties

• When mental health professional (MHP) interview was used as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. On the other hand, individuals scoring low (≤ 4) on the PHQ-9 had a less than a 1 in 25 chance of having depression.
• Construct validity of the PHQ-9 as a depression severity measure in relation to functional status, disability days, and health care utilization. 20-item Short-Form General Health Survey is used for functional status, self-reported sick days as disability days and clinic visits for health care utilization. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales whereas symptom-related difficulty, sick days, and health care utilization increased.
• Using the MHP re-interview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased.
• A study done in 2017 to assess co-relation of PHQ-2 with PHQ-9 in patients with mild to severe traumatic brain injury within 1 year of injury showed PHQ-2 scores ≥2 had a sensitivity of 0.90 in predicting PHQ-9 scores ≥10, and a sensitivity of 0.95 in predicting endorsement of any passive or active suicidal thoughts on the PHQ-9.