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

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 so fidgety or restless that you have been moving a lot more than usual?

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

0

Points

Please make an appointment for this patient

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).