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The Patient Health Questionnaire (PHQ-9) is a self-reported questionnaire assessing for depression symptoms.

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One of the main positives of the PHQ-9 is its applicability to diverse populations. Being translated into many languages self-administered makes it easy for clients of all backgrounds to do at home. Plus, it is a quick assessment containing only 9 questions.

The general finding is that it is a useful tool for screening for depression, but not for diagnosis, especially in a psychiatric setting (Inoue et. al, 2012). The general pros and cons of self-reported assessments are present in this tool as well, meaning that the counselor has to validate all of the answers given by the client in order to accurately assess for depression and other symptoms.

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Multicultural and Social Justice Considerations

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Multicultural and Social Justice Considerations

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The main constituent for using the PHQ-9 among clients is the age. It is meant for ages 12 and older, but even at that age, they may be confused as to some of the wording and overall meaning of the items.

Some of the items also ask about energy levels, appetite, sleeping patterns, etc. These can be affected by a number of disabilities, which can skew results and lead to a different interpretation of them. As with all screening tools and othera assessments, it's important to confirm the results using your clinical judgment, discussed in the "strengths/weaknesses" section (Cedergren, 2012).

While the PHQ-9 is translated in many languages, there will be no 100% match to the English version. For example, the phrase "feeling down" in item 2 can cause confusion in anyone outside of the U.S., so it is important to clear up any confusion associated with the wording used. However, there is a common concept of depression across African American, Chinese American, Latino and white groups which makes the instrument effective for monitoring of depression in these groups (Huang et. al, 2006; Cedergren, 2012).

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The original study for the PHQ-9 consisted of 6,000 patients across 8 primary care and 7 obstetrics-gynecology clinics, with 3,000 patients in each kind (Kroenke et. al, 2001). The results showed that as the severity on the PHQ-9 increased, there was a decrease in "functional status" on 6 Short-Form General Health Surveys, demonstrating construct validity.

Internal reliability was strong, with a Cronbach's α of 0.89 in the  primary care study and 0.86 in the Ob-Gyn study. This was showed in test-retest reliability as well, with a correlation of 0.84 with an interview by a mental health professional that assessed for present symptoms of depression.

Overall, the PHQ-9 is a reliable and valid measure for severity of depression, making it a useful clinical and research tool.

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Cedergren, C. (2012). The Effectiveness of the Patient Health Questionnaire-9 Across Cultures [Master’s capstone project, Minnesota State University, Mankato]. Cornerstone: A Collection of Scholarly and Creative Works for Minnesota State University, Mankato. https://cornerstone.lib.mnsu.edu/etds/549/

Huang, F. Y., Chung, H., Kroenke, K., Delucchi, K. L., & Spitzer, R. L. (2006). Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of general internal medicine, 21(6), 547–552. https://doi.org/10.1111/j.1525-1497.2006.00409.x

Inoue, T., Tanaka, T., Nakagawa, S., Nakato, Y., Kameyama, R., Boku, S., Toda, H., Kurita, T., & Koyama, T. (2012). Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care. BMC psychiatry, 12, 73. https://doi.org/10.1186/1471-244X-12-73

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Sun, Y., Fu, Z., Bo, Q., Mao, Z., Ma, X., & Wang, C. (2020). The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC psychiatry, 20(1), 474. https://doi.org/10.1186/s12888-020-02885-6

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The instrument can be used with adolescents aged 12+ and has been translated into various languages (found at https://www.phqscreeners.com/), making it applicable to a variety of backgrounds and other cultures.

Reviews:

Used to screen for depression and related disorders, Sun et. al (2020) concluded that the PHQ-9 showed high adaptability for patients with MDD, as well as high reliability and validity. They state that it is simple, rapid, and effective for the screening and assessing the severity of the depression.

This falls in line with what Gilbody et. al (2007) says in their analysis, stating that the PHQ-9 is acceptable and as good as other commonly used instruments in a range of settings, countries and populations.

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The Patient Health Questionnaire (PHQ)
and GAD-7 offer clinicians concise,
self-administered screening and diagnostic
tools for mental health disorders, which
have been field-tested in office practice.
The screeners are quick and user-friendly,
improving the recognition rate of
depression and anxiety and facilitating
diagnosis and treatment.

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diagnosing tools mental health disorders

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The Patient Health Questionnaire (PHQ) and GAD-7 offer clinicians concise, self-administered screening and diagnostic tools for mental health disorders, which have been field-tested in office practice. The screeners are quick and user-friendly, improving the recognition rate of depression and anxiety and facilitating diagnosis and treatment.

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The questions consists of 9 questions using a scale of 0-3, indicating the frequency of feelings of depression throughout the past 2 weeks.

The measure would be completed by the client before coming in, although it may be used at regular intervals depending on the stability of symptoms and treatment status.

The measure itself is in the public domain, so there is no specialized materials needed, and no training needed either. Although using the scores can elicit further assessment and treatment, we should use our clinical judgement to decide on any course of treatment, regardless of scores.

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I can see myself using this instrument in the future. The fact that it is available in so many languages makes it easy to administer in anyone that doesn't have English as their first language. I think it is a bit short, which is why I would use it in conjunction with other measures, like the Beck Depression Inventory or the Major Depression Inventory.

I like the fact that the items are drawn directly from the criteria from the DSM-V in forms of questions. This makes it very straightforward and easy to explain to clients. It is a measure to be used throughout the counseling process, as the answers are subject to change based on the mood of the client at the time of taking the assessment. When used with the other inventories on top of our personal clinical judgement, it can be a useful screening tool for clients suffering from depression.