Patient Health Questionnaire (PHQ-9)

Patient Health Questionnaire (PHQ-9)

Patient Health Questionnaire (PHQ) is a self-report inventory that is used for diagnosing and screening of multiple disorders such as depression, alcohol use, eating, and anxiety.

This tool was developed in the 1990’s by Pfizer Inc. 

The PHQ has different modules, a nine item version for assessing depression (PHQ-9), seven item versions that are used to assess anxiety (GAD-7) a fifteen item version that is used to identify somatic symptoms (PHQ-15). 

Some modules are combined and they can be helpful in assessing panic attacks.

These tests were originally designed as self-report inventories but they can be administered by health care practitioners and trained professionals.

The PHQ has been translated in more than 20 languages. 

Patient Health Questionnaire (PHQ-9)

This tool was developed by Dr. Spitzer, Williams and Kroenke. The PHQ-9 is one of the self-administered tools specifically for diagnosing depression.

This module scores nine of the DSM- IV criteria, this specific tool is not used to diagnose depression but it is used to monitor the severity of depression and response to treatment.

It can be specifically helpful in making a diagnosis of depression in at risk population such as those with coronary heart disease or after stroke. 

The PHQ-9 has been translated in more than 30 languages and it has been validated for use for different cultures and ethnicities. 

Administration 

The administration of PHQ-9 is quite simple. The test asks questions according to what the patient has felt over the last two weeks.

The questions asked are regarding mood (feeling down, hopeless), interest in activities, sleep disturbances, changes in appetite, energy levels, concentration difficulty, being restless or being lethargic, thoughts of self harming and feelings of disappointment. 

The items are then scored on the basis of a 4 point ordinal scale. The score ranges help in identifying the severity of the problem.  

A preview of the test has been shown, to give everyone an idea how the questions are. It can be used to identify any problem that a person is having but should not be used for self- diagnosing mental disorders.

If someone feels that he is having difficulty in these areas of his life should consult a health practitioner and get a proper diagnosis and should get the treatment specific for the diagnosis. 

Image result for phq 9

Scoring of PHQ-9 

 The scoring of PHQ-9 is very easy. It has 4 responses that range from “0” (Not at all) to “3” (nearly every day).

The scores are then helpful in identifying the varying levels of depression. The score range is from 0 -27. 

If the score is above 10, it highlights presence of depression.

The table below gives a complete description of the level of responses and the intervention that can be used for dealing with depression. 

PHQ-9 ScoreDepression severitySuggested Intervention
0-4None-minimalNone
5-9MildRepeat PHQ-9 at follow-up
10-14ModerateMake treatment plan, consider counseling, follow-up, and/or prescription drugs
15-19Moderately SeverePrescribe prescription drugs and counseling
20-27SeverePrescribe prescription drugs. If there are poor responses to treatment, immediately refer the patient to a mental health specialist for counseling.

As the PHQ-9 was made according to the DSM IV criteria but it can be used in diagnosing major depression disorder according to DSM 5.

According to the DSM 5 criteria, the provisional diagnosis for Major Depressive disorder can be given if 5 to 9 symptoms are present from the responses that are given in the test.

The presence of these symptoms should create an impairment in daily life functioning and these symptoms can’t be explained by substance or any other medical condition.

The PHQ-9 can be used to diagnose Major Depressive Disorder Syndrome but it also must be diagnosed using additional clinical administration. 

Reliability 

The PHQ-9 is considered to be quite reliable in primary settings.

This test is helpful and reliable in diagnosing depression in patients who are already having physical ailments.

Multiple studies with patients suffering from strokes, fibromyalgia, and chronic pain have shown how PHQ-9 has been helpful in diagnosing depression.

The patients involved were students, older adults and adolescents and some of them had physical disabilities

Applications 

PHQ-9 has been in use for a long time. It is an easy and reliable tool for diagnosing early symptoms of depression.

It is the most commonly used depression measure in the United Kingdom’s National Health Service.

It is also considered a standard measure for depression screening in The Veterans Administration, Department of Defense and Kaiser Permante. 

Different studies have shown that PHQ-9 is useful in psychiatric clinics for screening depression.

Studies have highlighted how patients with HIV AIDS, diabetes, chronic pain, epilepsy, arthritis, fibromyalgia and substance abuse have been properly screened for depression using the PHQ-9.

For further reading check the links below. 

Conclusion 

The PHQ-9 has been a reliable tool for diagnosing depression in clinical settings.

The items in the scale are easy to understand and they can be used in any primary setting.

This self- administration tool has been used with students, adults and adolescents and has shown valid results. 

These days people tend to use online tests to understand the problems that they are having and if anyone has used this test and have found that they are having difficulty in their daily life activities due to the presence symptoms.

They should consult a health practitioner and get a proper diagnosis for depression.

Mental disorders should be properly diagnosed and treated by a psychiatrist or psychologist. 

Please ask any questions or write your opinion about the article in the comments section below.

Citations

Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13.

Haddad M, Walters P, Phillips R, et al; Detecting depression in patients with coronary heart disease: a diagnostic evaluation of the PHQ-9 and HADS-D in primary UPBEAT-UK study. PLoS One. 2013 Oct 10 8(10):e78493. doi: 10.1371/journal.pone.0078493care, 

 Inoue, T.; Tanaka, T.; Nakagawa, S; et al. (2012). “Utility and Limitations of PHQ-9 in a Clinic Specializing in Psychiatric Care”. BMC Psychiatry. 12: 1–6. doi:10.1186/1471-244X-12-73. PMC 3416649. PMID 22759625.

 Van Steenbergen-Weijenburg, Kirsten; de Vroege, L; Ploeger, R.R.; et al. (2010). “Validation of the PHQ-9 as a Screening Instrument for Depression in Diabetes Patients in Specialized Outpatient Clinics”. BMC Health Services Research. 10: 1–6. doi:10.1186/1472-6963-10-235. PMC 2927590. PMID 20704720. Monohan, P.O.; Shacham, E; Reece, M; et al. (2009). “Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales Among Adults Living with HIV/AIDS in Western Kenya”. Journal of General Internal Medicine. 24 (2): 189–197. doi:10.1007/s11606-008-0846-z. PMC2629000PMID19031037

Patient Health Questionnaire (PHQ-9)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behavior, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.