128:. The items ask about the patient's experience in the last two weeks. Questions are about the level of interest/pleasure in doing things (anhedonia), feeling down or depressed, sleep-related problems (sleeping too much/difficulty falling or staying asleep), low energy or fatigue, eating problems (poor appetite or eating too much), self-worth (feeling like a failure), ability to concentrate, psychomotor problems (speaking/moving slowly or fidgety/restless), and thoughts of suicide. Responses range from “0” (Not at all) to “3” (nearly every day). A tenth question asks about the extent to which the previously mentioned symptoms make functioning in daily life difficult. The response to the tenth question is not factored into the final score; however, clinicians may use the response to help gauge the patient's level of impairment. A massive study of almost 60,000 participants (involving 29 samples from seven countries and speaking five languages) that employed exploratory
222:(questions 1 and 2 on the PHQ-9). Any degree of suicidal thoughts counts toward a provisional diagnosis. The symptoms must also cause significant distress and loss of function. The PHQ-9 is limited to making a provisional diagnosis. It cannot be used to make an actual diagnosis. Only a trained clinician can do that. For example, a trained clinician can determine if the symptoms can be better explained by substance use or another medical or psychiatric condition. Clinicians, however, may use the PHQ-9 to evaluate the efficacy of treatments for depression. A change of PHQ-9 score to less than 10 is considered a “partial response” to treatment and a change of PHQ-9 score to less than 5 is considered to be “remission.”
414:
Unlike the PHQ-9, the GAD-7 does not generate provisional diagnoses. A clinical interview must be given to arrive at a clinical diagnosis. The GAD-2 is a 2-question shortened version of the GAD-7; it uses the first two items on the GAD-7. A total score that is greater than 3 indicates that a clinician should administer the full GAD-7 and conduct a clinical interview to assess the presence and type of anxiety disorder.
404:. The questions on the PHQ-15 account for 90% of all symptoms that providers observe in primary care settings. Patients must rate the extent to which symptoms bothered them over the last month. Responses range from "not at all" (a score of 0) to "bothered a lot" (a score of 2). Higher scores on the PHQ-15 are strongly associated with functional impairment, disability, and healthcare utilization.
360:, and substance abuse. It also is used in studies involving patients with physical disabilities as well as older adults, students, and adolescents. The PHQ-9 has been extensively used in research investigating the relationship between burnout and depression. The instrument is available in over 30 languages and may be valid for use in different ethnic groups.
389:
resource restraints may leave researchers unable to intervene with study participants who indicate that they have experienced suicidal thoughts. The absence of the ninth question has little effect on scoring between the PHQ-8 and PHQ-9. A study found that scores between the two tests are highly correlated (
388:
consists of all of the PHQ-9 instruments except for the last question (suicidal thoughts). The 8-item version of the instrument is commonly used in research on general population samples, which mostly comprises individuals who are not depressed. Researchers generally use the PHQ-8 because timing and
940:
Smarr KL, Keefer AL (November 2011). "Measures of depression and depressive symptoms: Beck
Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9
413:
is a seven-item anxiety screening instrument developed in 2006 with a similar format to that of the PHQ-9. Total scores range from 0 to 21 with scores of 5, 10, and 15 indicating mild, moderate, and severe anxiety. Unlike the PHQ-9, clinicians use the GAD-7 to assess the severity of anxiety only.
242:
patients. However, some research suggests that the scale is not purely unidimensional, with the scale reflecting two latent factors, somatic and cognitive/affective factors. By contrast, the results of the massive study by
Bianchi et al. (2022) indicate that the PHQ-9's total score is essentially
250:
between PHQ-9 scores obtained from in-person and phone interviews with the same patients was 0.84. The PHQ-9 showed acceptable psychometric properties in a rural Indian population. In general, psychometric research supports the use of total scores, i.e., summing the item scores, in research and
140:
The total sum of the responses roughly indexes levels of depression. Scores range from 0 to 27. In general, a total of 10 or above is suggestive of the presence of depression. Listed below are PHQ-9 totals, the levels of depression that they relate to, and suggested treatment for each level of
78:'s larger suite of trademarked products, called the Primary Care Evaluation of Mental Disorders (PRIME-MD). The PHQ-9 takes less than three minutes to complete. It is scored by simply adding up the individual items' scores. Each of the nine items reflects a
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is a shortened version of the PHQ-9. It contains the first 2 questions of the PHQ-9 and takes less than a minute to administer. A score of 3 or greater on the PHQ-2 will generally lead to the subsequent administration of the PHQ-9. The
762:
Bianchi, R., Verkuilen, J., Toker, S., Schonfeld, I. S., Gerber, M., Brähler, E., & Kroenke, K. (2022). Is the PHQ-9 a unidimensional measure of depression? A 58,272-participant study. ‘’Psychological
Assessment, 34’’(6), 595–603.
1186:
Bianchi, R., Verkuilen, J., Schonfeld, I. S., Hakanen, J. J., Jansson-Fröjmark, M., Manzano-García, G., Laurent, E., & Meier, L. L. (2021). Is burnout a depressive condition? A 14-sample meta-analytic and bifactor analytic study.
218:, MDD is likely if five or more of the nine criterion symptoms are present for “most of the day, nearly every day" over the past 2 weeks; however, one of the symptoms must be either depressed mood or
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Preliminary work using gold standard readability measures suggests that a significant minority of patients might find interpretation of the PHQ-9 difficult without support.
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Meier, S. T., & Kim, S. (2022). Meta-regression analyses of relationships between burnout and depression with sampling and measurement methodological moderators.
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311:
993:
Kroenke K, Spitzer RL, Williams JB, Löwe B (2010). "The
Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review".
93:
120:
A patient may take the PHQ-9 in written form or be presented the survey items in interview form. The PHQ-9 questions reflect the diagnostic criteria for
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Prescribe prescription drugs. If there are poor responses to treatment, immediately refer the patient to a mental health specialist for counseling.
108:
disorders. Robert L. Spitzer, Janet B.W. Williams, and Kurt
Kroenke developed the PHQ in the mid-1990s and the PHQ-9 in 1999 with a grant from
1220:
1237:
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7.
132:
bifactor analysis showed the PHQ-9 is essentially unidimensional; cognitive-affective and somatic specific factors were relatively weak.
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adopted the PHQ-9 as a standard measure for depression screening. The PHQ-9 is also the most commonly used depression measure in the
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299:
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endorsed the PHQ-9 for measuring depression severity and responsiveness to treatment in adults in a primary care setting.
1089:"Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics"
567:
608:
262:, a mental health professional validated depression diagnoses from PHQ-9 scores from 580 participants, resulting in 88%
129:
71:
1087:
van
Steenbergen-Weijenburg KM, de Vroege L, Ploeger RR, Brals JW, Vloedbeld MG, Veneman TF, et al. (August 2010).
267:
263:
722:
258:, Kroenke et al. found that the correlation between the PHQ-9 and the SF-20 mental health scale was 0.73. To assess
92:
The PHQ-9 is the nine-item depression scale found in the 59-item PHQ. The PHQ is a self-administered version of the
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121:
510:
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Kroenke, Spitzer, and
Williams conducted validity and reliability research on the PHQ-9 in 2001. With regard to
401:
303:
231:
105:
84:
symptom of depression. Primary care providers can use the PHQ-9 to screen for possible depression in patients.
1140:"Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya"
214:
A provisional diagnosis of MDD can be made by using the pattern of responses to PHQ-9 items. According to the
378:
307:
657:
423:
46:
42:
698:
893:
511:"Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME-MD 1000 Study"
894:"A readability analysis of the PHQ-9: How much of the general public may struggle to understand it?"
235:
62:) is a depressive symptom scale and diagnostic tool introduced in 2001 to screen adult patients in
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is a 15-item scale derived from the larger PHQ. The PHQ-15 inquires in 15 symptoms relating to
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for the PHQ-9 was 0.89 in a sample comprising 3,000 primary care patients and 0.86 among 3,000
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329:, which requires providers to use a depression screening instrument when treating depression.
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67:
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Monahan PO, Shacham E, Reece M, Kroenke K, Ong'or WO, Omollo O, et al. (February 2009).
96:, a screening tool that assesses 12 mental and emotional health disorders. It has modules on
70:
and a possible depressive disorder. The PHQ-9 is a component of the larger self-administered
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De Man J, Absetz P, Sathish T, Desloge A, Haregu T, Oldenburg B, et al. (2021-05-13).
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Inoue T, Tanaka T, Nakagawa S, Nakato Y, Kameyama R, Boku S, et al. (July 2012).
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clinics. Researchers have used the PHQ-9 to study the mental health of patients with
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1038:"Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care"
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Make treatment plan, consider counseling, follow-up, and/or prescription drugs
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859:
609:"Instruction Manual for Patient Health Questionnaire (PHQ) and GAD-7 Measures"
333:
1105:
804:
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843:"Are the PHQ-9 and GAD-7 Suitable for Use in India? A Psychometric Analysis"
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302:, the National Epidemiologic Survey on Alcohol and Related Conditions, the
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owns the copyright of the PHQ-9 and allows it to be accessed for free.
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Studies found the PHQ-9 is also useful for screening for depression in
74:(PHQ), but can be used as a stand-alone instrument. The PHQ is part of
27:
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settings. The instrument assesses for the presence and severity of
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37:
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Kroenke, Kurt; Spitzer, Robert L.; Williams, Janet B. W. (2001).
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649:
683:
Diagnostic and statistical manual of mental disorders: DSM-5-TR
32:
PHQ-9; PHQ Quick
Depression Assessment; Resident mood interview
781:"The PHQ-9: Validity of a brief depression severity measure"
459:"The PHQ-9: validity of a brief depression severity measure"
246:
The test-retest reliability was found to be excellent. The
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uses this method to screen for depression in patients.
457:
Kroenke K, Spitzer RL, Williams JB (September 2001).
288:
National
Institute for Health and Clinical Excellence
36:
26:
21:
1221:"Patient Health Questionnaire (PHQ-9 & PHQ-2)"
310:use the full PHQ-9 or a shortened form of it. The
296:National Health and Nutrition Examination Survey
1243:http://dx.doi.org/10.1001/archinte.166.10.1092
292:The Behavioral Risk Factor Surveillance Survey
1205:Journal of Occupational Health Psychology, 27
703:Pfizer's Patient-Centered Outcomes Assessment
8:
197:Prescribe prescription drugs and counseling
568:"PDF of the Patient Health Questionnaire-9"
681:American Psychiatric Association. (2022).
1277:Depression screening and assessment tools
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1193:https://doi.org/10.1177/2167702620979597
650:"Patient Health Questionnaire Screeners"
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22:Patient Health Questionnaire 9 item
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16:Self-report mood disorder questionnaire
1272:Anxiety screening and assessment tools
56:nine-item Patient Health Questionnaire
18:
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1144:Journal of General Internal Medicine
797:10.1046/j.1525-1497.2001.016009606.x
785:Journal of General Internal Medicine
739:from the original on 10 January 2022
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660:from the original on 10 January 2022
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475:10.1046/j.1525-1497.2001.016009606.x
463:Journal of General Internal Medicine
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1239:Archives of Internal Medicine, 166
1225:American Psychological Association
1209:https://doi.org/10.1037/ocp0000273
1007:10.1016/j.genhosppsych.2010.03.006
765:https://doi.org/10.1037/pas0001124
730:Patient Health Questionnaire (PHQ)
685:(5th ed.). Washington, DC: Author.
14:
1189:Clinical Psychological Science, 9
527:10.1001/jama.1994.03520220043029
306:Health Support program, and the
300:Medical Expenditure Panel Survey
1:
943:Arthritis Care & Research
910:10.53841/bpscpf.2021.1.347.18
1093:BMC Health Services Research
130:structural equation modeling
72:Patient Health Questionnaire
995:General Hospital Psychiatry
1293:
175:Repeat PHQ-9 at follow-up
1156:10.1007/s11606-008-0846-z
898:Clinical Psychology Forum
860:10.3389/fpsyg.2021.676398
509:Spitzer RL (1994-12-14).
136:Interpretation of results
122:major depressive disorder
1106:10.1186/1472-6963-10-235
226:Validity and reliability
1055:10.1186/1471-244X-12-73
949:(Suppl 11): S454–S466.
847:Frontiers in Psychology
723:"PHQ Screener Overview"
379:Veterans Administration
327:National Health Service
312:Veterans Administration
308:Millennium Cohort Study
153:Suggested Intervention
104:, alcohol, eating, and
654:Pfizer's PHQ Screeners
616:Pfizer's PHQ Screeners
575:Pfizer's PHQ Screeners
424:Psychological testing
316:Department of Defense
402:somatoform disorders
254:In an assessment of
150:Depression severity
892:Cuffe, Ray (2021).
699:"PCOA PHQ Screener"
368:Related instruments
124:(MDD) found in the
68:depressive symptoms
260:criterion validity
256:construct validity
234:, they found that
194:Moderately Severe
955:10.1002/acr.20556
521:(22): 1749–1756.
320:Kaiser Permanente
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354:fibromyalgia
346:chronic pain
331:
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282:Applications
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147:PHQ-9 Score
141:depression:
139:
125:
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116:Survey items
91:
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64:primary care
59:
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334:psychiatric
274:Readability
268:specificity
264:sensitivity
248:correlation
232:reliability
1266:Categories
941:(PHQ-9)".
853:: 676398.
743:10 January
708:2022-01-10
664:10 January
629:10 January
588:10 January
430:References
393:= 0.998).
251:practice.
106:somatoform
918:255873027
805:0884-8734
535:0098-7484
350:arthritis
220:anhedonia
183:Moderate
100:(PHQ-9),
1174:19031037
1125:20704720
1074:22759625
1023:34713999
1015:20633738
963:22588766
879:34054677
823:11556941
734:Archived
658:Archived
620:Archived
579:Archived
551:13836141
493:11556941
418:See also
358:epilepsy
342:HIV-AIDS
338:diabetes
304:Medicare
266:and 88%
94:PRIME-MD
28:Synonyms
1165:2629000
1116:2927590
1099:: 235.
1065:3416649
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110:Pfizer
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1019:S2CID
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914:S2CID
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