Depression

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It is estimated that about 14 percent of patients who visit a primary care provider are depressed, but that depression is often not diagnosed. Recently a diagnostic tool was redesigned to help primary care providers diagnose depression. That tool is called Patient Health Questionnaire 9 (PHQ9). There are nine questions listed below and four possible answers to each question. PHQ9 uses a scoring system to assess whether the patient is depressed and how severe that depression is. The scoring system is as follows: not at all – 0; several days – 1; more than half the days – 2; and nearly every day – 3. The nine questions are:

  1. Little interest or pleasure in doing things.
  2. Feeling down, depressed, or hopeless.
  3. Trouble falling or staying asleep, or sleeping too much.
  4. Feeling tired or having little energy.
  5. Poor appetite or overeating.
  6. Feeling bad about yourself or that you are a failure or have let yourself or your family down.
  7. Trouble concentrating on things, such as reading the newspaper or watching television.
  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.
  9. Thoughts that you would be better off dead or hurting yourself in some way.

A score of 5-9 represents mild depressive symptoms, 10-14 moderate, 15-19 moderately severe, and 20 or more severe depressive symptoms. The advantages of a publically accessible PHQ9 include its self-report format, rapid scoring and interpretation, availability in multiple languages, suitability for remote administration (e.g. via telehealth), and sensitivity to treatment-associated change. PHQ9 does not screen for bipolar disorder, so an elevated score should prompt questions related to bipolar depression, including asking about sustained periods of grandiosity, decreased need for sleep, or pressured sleep. PHQ9 also does not screen for anxiety, which often accompanies depression, so the examiner would need to ask additional questions related to anxiety. In addition questions regarding alcohol and/or controlled substance use and abuse should be asked in the setting of an elevated score.

Multiple depression scales exist but PHQ9 is designed to be used in the primary care setting. An elevated score will prompt the primary care provider to recommend medications to treat depression and/or the need for referral of the patient to a psychologist or a psychiatrist. Obviously, immediate referral to a specialist would be especially important if the patient scores high on question 9.

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