PHQ-9 Depression Scale Questionnaire

The PHQ-9 is a measurement tool providers can use to ensure measurement-based treatment to target within Collaborative Care. This concise nine-item health questionnaire can function as a screening tool, aids in diagnosis, and measures treatment response.

Advantages of the PHQ-9

Patient filling out PHQ-9

It is shorter than other depression rating scales
Multiple administration options (in person by a clinician, by telephone, or self-administered by the patient)
Facilitates diagnosis of major depression
Assesses symptom severity
Well-validated and documented in a variety of populations
Directly based on the nine diagnostic criteria for major depressive disorder in the DSM-5
Valid for use in adolescents as young as 12 years of age

How to Use the PHQ-9

At the initial visit, the PHQ-9 aids in the diagnosis and identification of potential depressive symptoms. At follow-up visits, it measures treatment response. The Questionnaire can be clinician or self-administered.

Scoring the PHQ-9

The PHQ-9 is a tool to assist clinicians in identifying and diagnosing major depression. It has a maximum score of 27. Elevated scores strongly correlate with a major depression diagnosis. However, it’s essential to remember that not everyone with a high PHQ-9 score will have major depression. Trained clinicians must make the final diagnosis.

Patient Health Questionnaire 2 (PHQ-2)

The Patient Health Questionnaire 2 (PHQ-2) effectively screens large groups for depression. It consists of the first two questions on the PHQ-9. If the patient responds affirmatively to either question on the PHQ-2, the PHQ-9 should be administered. No permission is required to reproduce, translate, display, or distribute the PHQ-2.

PHQ-9 Questionnaire and Translations

The PHQ-9, translations of the measure, and an instruction manual are available at www.phqscreeners.com. No permission is required to reproduce, translate, display, or distribute the PHQ-9.

Protocols for Suicide Prevention

The PHQ-9 asks about suicidal ideation, and clinics should have a plan in place for when a patient scores positive on this question. The Protocols for Suicide Prevention in Primary Care assists clinics in refining existing protocol(s) for responding to patients who present with suicidality or violent behavior.

PHQ-9 Aids

Introducing the PHQ-9

To increase staff comfort in discussing the PHQ-9 with patients, the AIMS Center provides the Helping Clinic Staff Talk about the PHQ-9 tool. This resource equips clinic staff to administer the PHQ-9 by addressing commonly asked patient questions.

PHQ-9 Visual Answer Aid

This answer aid visually represents the PHQ-9 answer scale: English | Spanish.

Brief Pain Inventory (BPI)

The Brief Pain Inventory is a medical questionnaire used to measure pain, developed by the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care.

Comparing Collaborative Care to Usual Care

Compared to usual care, Collaborative Care is shown to increase the effectiveness of depression treatment and lower total healthcare costs. This handout outlines those differences using data from the IMPACT trial.
Updated 1/2/19

Why Practice Collaborative Care?

The Collaborative Care Model (CoCM) has a robust evidence base with over eighty randomized controlled trials showing it is the best at treating depression in many populations and settings. CoCM is beneficial for Primary Care Providers (PCPs) and their patients because it offers an established evidence base, better medical outcomes, help with challenging patient cases, faster improvement, and the collaboration of a team.

We highly encourage that this document be shared with PCPs, stakeholders, and others looking to implement CoCM.

AUDIT-C

The AUDIT-C is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders (including alcohol dependence). The AUDIT-C is a modified version of the 10-question AUDIT instrument.

Generalized Anxiety Disorder subscale (GAD-7)

The Generalized Anxiety Disorder (GAD) subscale of the Patient Health Questionnaire (GAD-7) is a quick and easy tool to help identify patients with anxiety and monitor treatment response. The GAD-7 is available free for clinical use in a variety of languages at the link below.

Primary Care Provider (PCP) Role Description in Collaborative Care

The role of a primary care provider (PCP) in Collaborative Care is to oversee all aspects of the patient’s behavioral health care including encouraging the patient’s participation, prescribing medications, and making referrals to specialty mental health care when needed. They work in close consultation and collaboration with the patient’s Behavioral Health Care Manager and to a much lesser extent, the designated Psychiatric Consultant.

Tips for Discussing Trauma During an Initial Assessment

Trauma can increase the risk of health, social, and emotional problems. Despite the high prevalence of patients with a past history of trauma, few clinics or Collaborative Care teams have a protocol for addressing it. These three tips can help clinicians safely and effectively discuss the trauma history of their patients during their initial assessment.

Primary Care Provider Role Handout

Primary care providers (PCP) identify and engage patients in collaborative care, make diagnoses, and treat patients. This handout describes the role of the PCP in more detail.

PMQ-9 (Spanish)

The Spanish version of the Patient Mania Questionnaire (PMQ-9) is a nine-item scale used to assess and monitor manic symptoms. The PMQ-9 Mania Questionnaire complements use of the PHQ-9 for depressive symptoms to inform measurement-based care. It is also suited for use in mental health care settings. An English version of the PMQ-9 can be found here.