mood disorder phq-9© phq-9-ov© section d mood june 3, 2015 1-3pm
TRANSCRIPT
Mood Disorder
PHQ-9©
PHQ-9-OV©
SECTION D MOOD
June 3, 2015 1-3PM
Objectives
Understand the importance of identifying signs and symptoms of mood distress so these can be treated
Understand how to conduct the interviewUnderstand the Total Severity ScoreUnderstand the importance of including
this information on the care plan
D0100: Should Resident Mood Interview Be Conducted?
• Review:• Is resident rarely or never understood? (B0700)• Does resident want or need interpreter? (A1100)• Is interpreter available?
• Code 0. No. Interview should not be attempted• If resident rarely/never understood or
needs or wants interpreter but one not available. • SKIP to D0500: Staff Assessment of Resident Mood
• Code 1. Yes. Interview should be conducted• If resident at least sometimes understood, and if interpreter
needed or wanted, one is available.
D0200: Resident Mood Interview PHQ-9©
Patient Health Questionnaire - PHQ-9© 9-item validated interview
Screens for symptoms of depression.Standardized severity score Two part assessment:
Symptom presenceSymptom frequency
14 day look-back period – may include preadmission
D0200: PHQ-9©Conduct interview preferably day before or day of
ARDQuiet, private settingBe sure resident can see and hear youProvide paper form of interview if needed Explain reason for interview, “I am going to ask you some questions about
your mood and feelings over the past 2 weeks. I will also ask you about some common problems that are known to go along with feeling down. These may seem personal, but everyone is asked to answer them. It will help us provide you with better care.”
D0200: PHQ-9© Tell resident and show cue cards
“I am going to ask you how often you have been bothered by a particular problem over the last 2 weeks. I will give you the choices you see on this card.”
0-1 days—never or 1 day2-6 days—several days7-11 days—half or more of the days 12-14 days—nearly every day.”
D0200: PHQ-9©
Begin - “Over the past 2 weeks have you been
bothered by any of the following problems?”
For each questions (D0200A-I)Read as writtenDo not provide definitions, meaning based
on resident’s interpretationAsk each question in sequence before going
to next question:Presence in Column 1 Frequency in Column 2
D0200: PHQ-9© May respond to questions:
VerballyPointing to answers on cue card, orWriting out answers
Symptom FrequencySelect only one frequency response per itemChoose higher frequency if:
Difficulty choosing between two frequencies
More than one phrase in item and chooses different frequencies
D0200 – PHQ-9© Coding Symptom – Presence & Frequency
14 Day Look Back
D0200. Resident Mood InterviewOver the past two weeks have you been bothered by any of the
following problems?A. Little interest or pleasure in doing thingsB. Feeling down, depressed, or hopelessC. Trouble falling or staying asleep, or sleeping too muchD. Feeling tired or having little energyE. Poor appetite or overeatingF. Feeling bad about yourself – or that you are a failure or
have let yourself or your family downG. Trouble concentrating on things, such as reading the
newspaper or watching televisionH. Moving or speaking so slowly that other people could
notice. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual
I. Thoughts that you would be better off dead or hurting yourself in some way.
D0200 - PHQ-9© CodingCoding Column 1 - Symptom Presence
Code 0. No. Symptom not presentCode 1. Yes. Symptom presentCode 9. No Response. Resident unable or chose
not to complete assessment, responded nonsensically, and/or facility not able to complete assessment
Coding Column 2 - Symptom FrequencyCode 0. Never or experienced symptom 1 day onlyCode 1. Experienced symptom on 2-6 daysCode 2. Experienced symptom on 7-11 daysCode 3. Experienced symptom on12-14 daysLeave Blank – If Symptom Presence Code 9
D0300: PHQ-9© Total Severity Score• Calculation:
• Add Numeric Scores D0200: Column 2• If any dashes or blanks - Appendix E -3• Software calculate
• If Frequency “blank” for 3 or more items• Code Total Severity Score as 99• Complete D0500: Staff Assessment of Resident
Mood
INTERVIEWING VULNERABLE ADULTS
Here’s the link;http://
www.youtube.com/watch?v=Ereawm4_F7k
D0300: PHQ-9© Total Severity Score Extent of potential depression symptomsStandard score communicate to authorized
staffTracking of symptoms and changes in
symptoms over time
Score Interpretation at Coding Tips & Special Populations Major and Minor Depressive Syndrome
01 - 04: Minimal Depression10 - 14: Moderate Depression 05 - 09: Mild Depression15 - 19: Moderately Severe Depression20 - 27: Severe Depression
D0350: Safety NotificationComplete only if D0200.I. “Thoughts that you
would be better off dead or of hurting yourself in some way” = 1. Yes
Was responsible staff or provider informed that there is a potential for resident self harm?Code 1. No. Responsible staff or provider not
informed potential for resident self-harm.Code 2. Yes. Responsible staff or provider
informed.
D0500: Staff Assessment of Resident Mood – PHQ-9-OV©
Assess mood of resident unable to complete interview
Ensure information about mood not overlooked
Coding presence of indicators does not automatically mean diagnosis
of depression of other mood disorder
D0500: Staff Assessment PHQ-9-OV©
14 day look-back periodInterview staff from all shifts who know
resident bestSame interview process, techniques, &
higher symptom frequency choice used in resident interview
Report symptom even if believe unrelated to depression
If resident in facility <14 days, ask family, others & review transfer information
D0500. Staff Assessment of Resident Mood Over the past two weeks did the resident have any of the
following problems or behaviors?A. Little interest or pleasure in doing thingsB. Feeling down, depressed, or hopelessC. Trouble falling or staying asleep, or sleeping too muchD. Feeling tired or having little energyE. Poor appetite or overeatingF. Indicating that s/he feels bad about self – or has let self or
family downG. Trouble concentrating on things, such as reading the
newspaper or watching televisionH. Moving or speaking so slowly that other people have
noticed. Or the opposite – being so fidgety or restless that s/he has been moving around a lot more than usual
I. Stresses that life isn’t worth living, wishes for death, or attempts to harm self
J. Being short tempered, easily annoyed
D0500: Symptom Presence & Frequency Coding14 Day Look Back
D0600: Total Severity Score PHQ-9©
• Calculation: • Add Numeric Scores D0200. Symptom
Frequency (Column 2)• If any dashes or blanks - Appendix E• Software calculate
• Interview complete if staff provide at least 8 out of 10 frequency responses
Total Severity Score Interpretation
1-4: minimal depression5-9: mild depression10-14: moderate depression15-19: moderately severe
depression20-30: severe depression
D0650: Safety NotificationComplete only if D0500.I. “States that Life isn’t
Worth Living, Wishes for Death, or Attempts to Harm Self” = 1. Yes
Was responsible staff or provider informed that there is a potential for resident self harm?Code 1. No. Responsible staff or provider not
informed potential for resident self-harm.Code 2. Yes. Responsible staff or provider
informed.
Care Plan Considerations
Depression can be associated with psychological and physical distress, decreased participation, decreased function, and poorer outcomes
Interventions need to be identified that could address symptoms
Questions?
I’ll take the next few minutes to answer any questions you might have
Thank you!!
Please feel free to contact me
Shirley L. Boltz, RNRAI/Education Coordinator