MedEd PPD

PHQ-9

Name: Patient Health Questionnaire (PHQ-9)

Source: Kroehnke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a Brief Depression Severity Measure. J Gen Intern Med. 2001;16:606-613. Click here for a sample of the PHQ-9. You must agree to the terms and conditions in order to view or download this tool.

Description: The PHQ-9 is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which derives its scoring system from the 9 DSM-IV criteria for depressive disorders. While the PHQ-9 demonstrated strong sensitivity, specificity, and positive predictive value scores, longitudinal studies are needed to ascertain sensitivity to change. A benefit of using the PHQ-9 in postpartum women is that while it has not been validated in this setting, it is a validated depression screening tool that is linked to DSM-IV criteria, and therefore as a screening tool, can be reimbursed for billing purposes. Sensitivity, specificity, and positive predictive values were similar in the primary care and obstetrics-gynecology samples.

Scores: Minor depression (cutoff: 0-9); moderate/moderately severe depression (cutoff: 15-19); severe depression (cutoff: 20-27). A positive score on the question, "Thoughts that you would be better off dead or of hurting yourself in some way" counts if present at all, regardless of duration.

Accuracy: According to Kroehnke and colleagues, the PHQ-9 had the following sensitivity (testing positive), specificity (testing negative), and positive predictive values for major depression, with scores >10:

Sensitivity: 88%

Specificity: 88%

Positive predictive value: 31%-51% – depending on cutoff

Time frame: The PHQ-9 takes less than 3 minutes to complete. [Spitzer et al, 1999]

Cost of the tool: Free.

Relevant literature about the PHQ-9:

Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006 Jun;21(6):547-552.

Grypma L, Haverkamp R, Little S, Unutzer J. Taking an evidence-based model of depression care from research to practice: making lemonade out of depression. Gen Hosp Psychiatry. 2006 Mar-Apr;28(2):101-107.

Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006 Jan-Feb;28(1):71-77.

Bergus GR, Hartz AJ, Noyes R Jr, Ward MM, James PA, Vaughn T, Kelley PL, Sinift SD, Bentler S, Tilman E. The limited effect of screening for depressive symptoms with the PHQ-9 in rural family practices. J Rural Health. 2005 Fall;21(4):303-309.

Ruoff G. A method that dramatically improves patient adherence to depression treatment. J Fam Pract. 2005 Oct;54(10):846-852.

Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, Blanco E, Haro JM. Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone? J Gen Intern Med. 2005 Aug;20(8):738-742.

Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999 Nov 10;282(18):1737-1744.