Ask the patient: how often have they been bothered by the following over the past 2 weeks?

1. . How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?

2. How often do you have difficulty getting things in order when you have to do a task that requires organization?

3. How often do you have problems remembering appointments or obligations?

4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?

5. . How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?

6. How often do you feel overly active and compelled to do things, like you were driven by a motor?

7. How often do you make careless mistakes when you have to work on boring or difficult projects?

8. How often do you have difficulty keeping your attention when you are doing boring or repitive work?

9. How often do you have difficulty on what people say to you, even when they are speaking directly to you?

10. How often do you misplace or have difficulty finding things at home or at work?

11. How often are you distracted by activity or noise around you?

12. How often do you have to leave your seat in meetings or other situations in which you expected to remain seated?

13. How often do you feel restless or fidgety?

14. How often do you have difficulty unwinding and relaxing when you have time to yourself?

15. How often do you find talking too much when you are in socal sitautions?

16. When you are in conversation, how often do you find yourself finishing the sentences of this people you are talking to before they can finish themselves?

17. How often do you have difficulty waiting in turn in situations when turn taking is required

18. How often do you interrupt others when they are busy?

0

Points

Scores ≤4 are less likely to be consistent with Adult ADHD.

ADVICE

Final diagnosis should be made with clinical interview and mental status examination including assessment of patient’s level of distress and functional impairment.

MANAGEMENT

PHQ-9 Management Summary
Score Depression severity Comments
0-4 Minimal or none Monitor; may not require treatment
5-9 Mild Use clinical judgment (symptom duration, functional impairment) to determine necessity of treatment
10-14 Moderate
15-19 Moderately severe Warrants active treatment with psychotherapy, medications, or combination
20-27 Severe

CRITICAL ACTIONS

  • Perform suicide risk assessment in patients who respond positively to item 9 “Thoughts that you would be better off dead or of hurting yourself in some way.”
  • Rule out bipolar disorder, normal bereavement, and medical disorders causing depression.

FORMULA

Addition of the selected points.

FACTS & FIGURES

The PHQ-9 is a validated, 9-question tool to assess for the degree of depression present in an individual; the last question is not scored, but is useful functionally to help the clinician assess the impact of the patient's symptoms on his or her life.

EVIDENCE APPRAISAL

The PHQ-9 was initially developed by Kroenke et al (2001), as a subset of 9 questions from the full PHQ, which had previously been derived and studied in a cohort of 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics (Spitzer 1999). PHQ-9 scores ≥10 were found to be 88% sensitive and also 88% specific for detecting MDD. Criterion validity was also assessed in a sample of 580 patients.

The PHQ-9 has also been validated in several additional subpopulations, including in psychiatric patients (Beard 2016), patients with medical comorbidities such as multiple sclerosis (Ferrando 2007) and Parkinson’s disease (Chagas 2013), pregnant patients (Sidebottom 2012), and in an occupational health setting (Volker 2016).

A meta-analysis of 29 studies including 6,725 patients found similar sensitivity (88%, 95% CI 83-92%) and specificity (85%, 95% CI 82-88%) for a cutoff of ≥10 as did the previous studies, both overall and for subgroups. Notably, they found that when used in the primary care setting, only approximately 50% of patients screening positive on the PHQ-9 in fact had major depression (Levis 2019).