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The Patient Health Questionnaire (PHQ-9) is a screening tool which can be used to make a preliminary diagnosis of depression, to assess the severity of depression or to monitor patients receiving treatment for depression. Our project involved completing a number of role plays using the screening tool, in different settings and with the patient displaying different levels of severity in low mood.

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Patient Health Questionnaire PHQ-9

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The PHQ-9 is well validated as a screening tool and research has show a strong correlation between higher scores and a later diagnosis of clinical depression.

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The PHQ-9 is shorter and simpler than some other screening tools for depression such as Beck's Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) and can be administered in many settings in person, over the telephone or self-administered.

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Following the assessment of a patient using the PHQ-9 questionnaire, little advice is provided on next steps based on the results of the test and on the futher management or treatment of the patient. The comment on treatment for patients assessed as having mild or moderate depression suggests using clinical judgement, for example, symptom duration and functional impairment which would need further investigation.

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As a quick screening tool for depression the PHQ-9 has been shown to be effective but as it is limited by focusing on a timeframe of two weeks it could perhaps be improved by including a question on the duration of the symptoms to aid clinical judgement on treatment.

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When scoring there is not much advice about what treatment should be offered and is just concluded with use clinical judgment which is very vague and not helpful. It could be that same patient seen by different nurses could end up with different treatment plans or no treatment at all. Also there is no differentiation between mild and moderate depression.

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PHQ-9 tool is not taking under consideration pre-existing conditions which could affect person's score such as  experiencing insomnia or eating disorders which could lead to higher score on some of the questions  and in process receive higher total score and could be misdiagnose with more severe depression.

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Tool would be great to monitor people with diagnosed depression and help determine the effectiveness of treatment. Due to it's simplicity, it doesn't require any training and could be used as self reporting 2 weekly assessment for patients and sent to clinicians who could than review progress of illness.

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Some of the questions could be very sensitive and make people reluctant to answer truthfully. The example could be the question 9 which asks about thought to end your life. There is still a lot of stigma about suicide and people might not want to admit that they ever considered it. In some religions suicide is a sin and sign of weakness.

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Due to its simplicity and only 9 questions asked it could miss some of the symptoms which are not included in test and would be relevant to tested people. Also it's simplicity could mean the patient finds some questions ambiguous. It is important to ask the patient to expand on their answers where necessary.

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Further more, the use of PHQ -9 should include a section for the past medical history of the patient. This would assist in getting an accurate assessment for the depression level .

Poor appetite or over eating on question 4 might not be as a result of the depression but rather as a result of the medications taken at the moment. The tool could be improved by taking into account the patient's current prescribed medication and any side effects.