The Patient Health Questionnaire(PHQ 9) is a self-administered instrument used for diagnosing various mental disorders. PHQ 9 is the subset of the PHQ instrument used to measure the severity of depressive mental disorders. In other words, PHQ 9 is the depression module of PHQ with 9 items, considered a short scale with accurate detection of depression and assessment of its severity, which guides to further treatment decisions. This easy to use patient questionnaire has been validated as the best to use in primary care for the early diagnosis of depression and the related mental disorders.
When it comes to mental health diagnosis or treatment, health practitioners' biggest issue is people's hesitant mentality to open up. In a primary care set-up, it is difficult to make people talk about their mental health issues without building trust. So there comes the need for self-administered tools like PHQ, PHQ 9, or PHQ 2, which helps to initial diagnosis and clinching to further treatment.
To understand PHQ 9 better, we share some useful information on Depression and related mental disorders. Some emotions, like sadness, grief, and feeling lost, are normal in every human. We all will come across these emotions from time to time, but they usually go away within a few days. What happens when these emotions are so persistent and overwhelming. Depression is a diagnosable condition classified as a mood disorder with symptoms like a deep-rooted sadness, lack of interest, low energy, and loss of appetite.
Overlooked or untreated depression can cause serious damage to your health. Several studies proved that severe depression can impact your central nervous system, and even it can affect the brain's physical structures. As of 2017, 264 million people around the world have depression, according to the World Health Organisation. So diagnosing depression at the early stage and proceeding to treatment can lower the life risk.
Today everybody around us is leading a life coping with one or other stress and mental problems; some pay attention to it and try to handle it or seeks help from others. But some people miss noting what they are going through deep inside, suffering to solve but not willing to know the reason behind it. Depression is one such condition that seriously affects your inner harmony, lack of interest in life, or loss of productivity. When you cannot sort out what you are going through inside, you cannot solve what you are being affected by outside.
You may have little interest in doing things. Your interest in everything gradually decreased; this seems like nothing in your opinion, but it is one of the most important symptoms of depressive disorders. A test instrument like PHQ 9 comes to the rescue at this point; it assesses the major symptoms of depression. That scoring will help you diagnose the severity of depression, and it also helps in the case of measuring the response to treatment.
The original PHQ instrument consists of 67 items based on PRIME-MD, which was developed a decade ago to help clinical practitioners to diagnose common mental disorders. This PHQ 9 is the depression module of PHQ; it consists of 9 questions based on the Diagnostic and Statistical Manual for Mental Disorders-IV criteria. The 9 questions help identify the core symptoms of severe depression; it is measured against 4 standard responses. The 4 response categories are "not at all," "several days," "more than half the days," "nearly every day.” The person taking up a depression test through PHQ 9 will be assessed with how many times they underwent these 9 depression symptoms in the past two weeks.
Check your depression level through PHQ 9 Questionnaire by Block Survey.
The PHQ 9 score is calculated by assigning 0,1,2,3 for the respective responses starting from “not at all” to “nearly every day,” then adding them together for all the 9 items. Usually, the PHQ 9 score ranges from 0 - 27. The PHQ 9 score's interpretation is based on the cut-of value; the scores are divided into 4 cut points, like 5,10,15, and 20.
Mild depression - When the PHQ 9 score is less than or equal to 5, it comes under mild depression. It is just feeling blue temporarily for a longer time. More irritable feelings or anger, self-hating, persistent hopelessness. These depressions are easiest to treat; certain changes in lifestyle and sleep patterns can work best to come out o it.
Moderate depression - It is diagnosed by a PHQ 9 score of around 10. The major symptoms of moderate depression are lack of motivation, loss of interest in doing things, lack of productivity. This type of depression needs a professional health practitioner since it needs some anti-depressants and guidance.
Moderately severe depression - When the score is around 15, it comes under moderately severe. The symptoms are aches and pains without any direct cause, Insomnia, appetite changes, weight changes, excessive worrying, etc.
Severe depression - When the score is 20 and more, then it is severe depression. These types of depression episodes mostly last longer periods like 6 months or a year in some people. The major symptoms are delusions, hallucinations, feelings of stupor, and suicidal thoughts or behavior. People with this type of depression needs medical treatment as soon as possible. A combination of medicines and therapy will make positive progress in patients with severe depression.
PHQ 9 has been validated with a large no. of people in many countries around the world. PHQ-9 scores > 10 had a sensitivity of 88% and a specificity of 88% for Major Depressive Disorder (source: National Centre for Biotechnology Information ). The reliability and validity of the tool have indicated it has sound psychometric properties.
Internal consistency - PHQ 9 produces a similar score compared with the other measures used to assess depression. So it exhibits excellent internal consistency.
Criterion Validity - It means the extent to which a measure is related to the outcome. PHQ 9 is proven to be a useful tool with strong criterion validity for identifying major depressive disorder cases.
Test-retest reliability - PHQ 9 shows the same score for respondents even after a period of time when the traits have not been changed.
Depression is one of the priority conditions covered by WHO’s mental health Gap Action Programme (mhGAP). The program aims at helping people with mental and neurological problems in various countries around the world. Globally, 15% of people will experience depression at some point in their lifetime. Suicide is the 10th leading cause of death in the United States, and depression is the major reason for suicidal thoughts. Depression should not be taken easily; it may affect your quality of life, physical health, and inner peace. Be aware of what you are going through, and early treatment can reduce the damage caused to your inner harmony.
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