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Patient Health Questionnaire - 9 (PHQ-9) Depression Scale
Availability
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Classification
Supplemental – Highly Recommended: Headache, Spinal Cord Injury (SCI) and SCI-Pediatric (ages 12 and older)
 
Supplemental: Epilepsy, Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion), and Traumatic Brain Injury (TBI).
 
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
The PHQ-9 is a screening tool that is specific to depression. This 9 item measure asks participants whether and how often they have been bothered by depression related symptoms over the last two weeks.
Comments
Rationale: PHQ-9 is a valid screening measure for major depressive disorder in people with SCI assessed during their initial inpatient rehabilitation. At a slightly higher cutoff than usual (greater than or equal to 11), the PHQ-9 has a sensitivity of 100% and a specificity of 84% and met stringent criteria for an adequate diagnostic test (Youden criterion). The PHQ-9 has also been found to be sensitive to change in the context of a clinical trial of antidepressant treatment as the “gold standard” Hamilton Depression Rating Scale and some other measures.
 
Sport-Related Concussion-Specific: Well validated, widely used screening instrument for depression symptoms. Although not a diagnostic instrument, at higher cut-off levels there is a high correlation with diagnostic interviews.
 
Age Range: 13 years and older
Scoring
9 items are scored on a scale of 0 to 3, resulting in a total score of 0 to 27 for depression severity:
 
0 = not at all
1 = several days
2 = more than half the days
3 = nearly every day
Total Scores: (Kroenke, et al., 2001)
 
0-4 indicates minimal depression (no treatment action required)
 
5-9 indicates mild depression (watch and repeat PHQ-9 at follow-up)
 
10-14 indicates moderate depression (treatment plan and counseling recommended and/or pharmacotherapy)
 
15-19 indicates moderatey severe depression depression (active treatment with pharmacotherapy and/or psychotherapy)
 
20-27 indicates severe depression (Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management)
Rationale/Justification
Sensitivity: The PHQ-9 is a valid screening measure for major depressive disorder in people with SCI assessed during their initial inpatient rehabilitation. At a slightly higher cutoff than usual (greater than or equal to 11), the PHQ-9 has a sensitivity of 100% and a specificity of 84% and met stringent criteria for an adequate diagnostic test (Youden criterion). The PHQ-9 has also been found to be sensitive to change in the context of a clinical trial of antidepressant treatment as the “gold standard” Hamilton Depression Rating Scale and some other measures.
 
Administration: 1 to 3 minutes; paper and pencil.
 
SCI-specific notes: This instrument has excellent internal consistency, as it showed promise as a tool with which to identify probable Major Depressive Disorder in people with SCI (Bombardier et al 2004).
 
A shortened version of the PHQ-9 with just questions 1, 2 and 6 may be used to increase efficiency and reduce gender effects of the 9 item questionnaire (Graves and Bombardier, 2008).
References
Fann JR, Bombardier CH, Dikmen S, Esselman P, Warms CA, Pelzer E, Rau H, Temkin N. Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehabil. 2005;20(6):501–511.
 
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.
 
Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care. 2004;42(12):1194–1201.
 
Maizels M, Smitherman TA, Penzien DB. A review of screening tools for psychiatric comorbidity in headache patients. Headache. 2006;46 Suppl 3:S98–S109.
 
SCI-specific:
Bombardier CH, Kalpakjian CZ, Graves DE, Dyer JR, Tate DG, Fann JR. Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil. 2012;93(10):1838–1845.
 
Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG. Symptoms of major depression in people with spinal cord injury: implications for screening. Arch Phys Med Rehabil. 2004;85(11):1749–1756.
 
Graves DE, Bombardier CH. Improving the efficiency of screening for major depression in people with spinal cord injury. J Spinal Cord Med. 2008;31(2):177–184.
Recommended Instrument for
Epilepsy, Headache, SAH, SCI, SCI-Pediatric, SRC and TBI
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