.-

The Patient Health Questionnaire (PHQ-9 - Overview

The PHQ-9 is a multipurpose instrument for screening, di nosing, monitoring and

measuring the severity of depression:

• The PHQ-9 incorporates DSM-IV depression diagnostic riteria with other leading

major depressive symptoms into a brief self-report tool

• The tool rates the frequency of the symptoms which f tors into the scoring

severity index.

• Question 9 on the PHQ-9 screens for the presence and duration of suicide ideation.

• A follow up, non-scored question on the PHQ-9 scree and assigns weight to the

degree to which depressive problems have affected th patient's level of function .

Clinical Utility

The PHQ-9 is brief and useful in clinical practice. The PHQ- is completed by the patient in

minutes and is rapidly scored by the clinician. The PHQ-9 c n also be administered repeatedly,

which can reflect improvement or worsening of depressio in response to treatment.

Scoring

See PHQ-9 Scoring on next page.

Psychometric Properties

• The diagnostic validity of the PHQ-9 was established i studies involving 8 primary care

and 7 obstetrical clinics.

• PHQ scores " 1 0 had a sensitivi ty of 88% and a specif ity of 88% for major depression.

• PHQ-9 scores of 5, 10, 15, and 20 represents mild, m erate, moderately severe and

severe depression.'

1. Kroenke K, Spitzer R, Williams W The PHO-9: Validity of a brief de ression severity measure. JGIM, 2001,

16:606-616

The Patient Health Questionnaire (PHQ-9 Scoring

Use of the PHQ-9 to Make a Tentative Depression Diagno is: The clinician should rule out physical causes of depression, nor al bereavement and a history of a manic/hypomanic episode

Step 1: Questions 1 and 2 Need one or both of the first two questions endorsed as a "2" r a "3" (2 = "More than half the days" or 3 = "Nearly every day")

Step 2: Questions 1 through 9

Need a total of five or more boxes endorsed within the shaded rea of the form to arrive at the total symptom count. (Questions 1-8 must be endorsed as a "2" or "3"; Question 9 must be endorsed as "1" a "2' ora "3")

Step 3: Question 10 This question must be endorsed as "Somewhat difficult" or "V ry difficult" or "Extremely difficult"

Use of the PHQ-9 for Treatment Selection and Monitorin

Step 1 A depression diagnosis that warrants treatment or a treatment hange, needs at least one of the first two questions endorsed as positive ("more than half the days" r "nearly every day") in the past two weeks. In addition, the tenth question, about difficulty at work r home or getting along w ith others should be answered at least "somewhat difficult"

Step 2 Add the total points for each of the columns 2-4 separately (Column 1 = Several days; Column 2 = More than half the days; olumn 3 = Nearly every day. Add the totals for each of the three columns together. This is the Total are The Total Score = the Severity Score

Step 3 Review the Severity Score using the following TABLE.

PHQ-9 Score Provisional Diagnosis Treatl nent Recommendation

5-9

10-14

t 5-19

>20

Minimal Symptoms'

Minor depression ++ Dysthymia' Major Depression, mild

Major depression, moderately severe

Major Depression, severe

Patien t Preferences should be considered

Supp t, educate to call if worse, retur in one month

Supp t, watchful waiting

Antid pressant or psychotherapy

Antid pressant or psychotherapy

Antid pressant or psychotherapy

Antid pressant and psychotherapy

(espe ally if not improved on monotherapy)

+ If symptoms present ~ two years, then probable chronic depressio which warrants antidepressants or

psychotherapy (ask "In the past 2 years have you felt depressed or d most days, even if you felt okay

sometimes?")

++ If symptoms present ~ one month or severe functional impairmen consider active treatment

The Patient Health Questionnaire (PHQ-~

Patient Name ----------------1- Date of Visit ______ _

Over the past 2 weeks, how often have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things

2. Feeling down, depressed or hopeless

3. Troub le falling asleep, 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're a failu re or have let yourself or your family down

7. Trouble concentrating on things, such as read ing the newspaper or watching television

8. Moving or speaking so slowly that other people could have noticed. Or, the opposite -being so fidgety or rest less that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead or of hurting yourself in some way

Not tall

o o

o

o

o

o

o

o

o

Column Tot Is

Add Totals Toget er

Several More Days Than Half

the Days

1 2

2

2

2

2

2

2

2

2

+ +

Nearly Every Day

3

3

3

3

3

3

3

3

3

10. If you checked off any problems, how difficult have t ose problems made it for you to

Do your work, take care of things at home, or get al ng with other people?

o Not difficult at all 0 Somewhat difficult 0 Very difficult 0 Extremely difficult

C 1999 pfizer Inc. All rights reserved. Used with permission

Over the last 2 we been bothered by

(Use" y ' to indica

1. Feeling ne

2. Not being

3. Worrying t

4. Trouble rei

5. Being so r

6 . Becoming

7. Feeling at might hap

If you checked off do your work, tak

Not difficult at all 0

From the Primary Care was developed by Drs. information , contact Dr.

• GAD·7 An

T his is calculated by assi "s everal days," "more tha fo r the seven items rang

S 1

cores represent: 0-5 m 5·21 severe anxiety.

GAD-7 Anxietll

ks, how often have you More than he following problems? Not Several

half the Nearly

at all days every day e your answer" days

vous, anxious or on edge 0 1 2 3

ble to stop or control worrying 0 1 2 3

o much about different things 0 1 2 3

xing 0 1 2 3

stless that it is hard to sit still 0 1 2 3

asily annoyed or irritable 0 1 2 3

id as it something awful 0 1 2 3 en

Column totals : + + + - - - -

= Total Score --

!!!!y problems, how difficult have these problems made it for you to care of things at home, or get along with other people?

Somewhat Very Extremely difficult difficult difficult

0 0 0

valuation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ). The PHQ obert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues . For research

Spitzer at rls8@columbia,edu. PRIME-MOO is a trademark of Pfizer Inc. CODvriah~ 1~Qq

;etv -Sever;t";. '" . .

ning scores of 0, 1, 2, and 3, to the re: ponse categories of "not at all ," 1 half the days," and "nearly every day, respectively. GAD-7 total score

s from 0 to 21 .

d 6-10 moderate 11 .15 moderately severe anxiety

Sheehan Disability Scale (50S) - Overview

The Sheehan Disability Scale (SDS) was developed to assess undional

Impairment in three inter-related domains; work/school, so ial and family life.

It is used by researchers and practicing clinicians.

Clinical Utility

• The SDS is a brief self-report tool.

• The patient rates the extent to which work/school, soci life and home life or family

responsibilities are impaired by his or her symptoms on 10 point visual analog scale.

• This 10 point visual analog scale uses spatiovisual, num ic and verbal descriptive

anchors simultaneously to assess disability.

• The author indicates that this range of anchor options a dresses the various ways that

Individuals approach rating a continuum.

Scoring'

• The numerical ratings of 0-10 can be translated into a rcentage, if desired.

• The 3 items can also be summed into a single dimensio al measure of global functional

impairment that rages from 0 (unimpaired) to 30 (highl impaired).

• There is no recommended cutoff score; however, chang -over-time in scores will be of

interest to clinicians in monitoring response to treatme

• It is recommended that clinicians pay special attention t patients who score 5 or greater

on any of the three sca les, because such high scores ar associated with significant

functional impairment .

Psychometric Properti es

The following sensitivity and specificity is for patients wi th ny of the following six mental

disorders (alcohol dependence, drug dependence, general nxiety disorder, major depressive

disorder, obsessive compulsive disorder and panic disorder '

Sensitivity 83 %

Specificity 69%

1. Rush lA, et at. Handbook of Psychiatric Measures, 2000 American Ps chiatric Association, 113-115.

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Sheehan Disability Scale

A brief, patient rated , measure of disability and im airment.

Please mark ONE circle for each scale.

WORK- I SCHOOL

The symptoms have disrupted your we k I school work:

Not at aU Mildly Moderately Marketdly Extremely

@ ~ I ~ ~ ~ ~ I I -.!. -.!. 3 4 ~ -.!, .2.- -7-- 9 I.

~ ~ ~

D I have not worked I studied at all during the past week for r sons unrcaltcd to the disorder . • Work includes paid, unpaid volunteer work or training

SOCIAL LIFE

The symptoms have disrupted your social I fe I leisure activities:

Not at all Mildly Mod&f"ately Marketdly Extremely

I I I I I I I I I

• 1 2 3 4 5 • 7 • 9 I.

FAMILY LIFE I HOME RESPON IBILITIES

The symptoms have disrupted your family life home responsibilities :

Not 8tall Mildly Moderately Markeldly Extremely

'0' ~ ~ I I I ~ I ~ ~ 'iii' --!.- -.!. ~ 4 ~ ..!. 7 -.!.. -.!.. ~ ~ ~ ~

Days Lost

On how many days in the last week did your symptoms use you to miss school

or w ork or leave you unable to carry out your normal dai responsibilities? -----

Days Unproductive

On how many days in the last week did you feel so impa ed by your symptoms,

that even though you went to school or work, your prod ctivity was reduced? -----

<C> Copyrigh t 1983 David V. Sheehan. All Righ ts Reserved.