Patient Health Questionnaire (Phq-9) Page 2
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2PHQ-9 Screening and Diagnosis
PHQ‐9 Quick Depression Assessment for Initial Diagnosis:
•
If there are at least 4 positive responses in the “More than half the days” or “Nearly every day”
columns (including Questions #1 and #2), consider a depressive disorder. Add scores to
determine severity.
•
Consider Major Depressive Disorder if there are at least 5 positive responses in the “More than
half the days” or “Nearly every day” columns (one of which is Question #1 or #2).
•
Consider Other Depressive Disorder If there are 2-4 positive responses in the “More than half the
days” or “Nearly every day” columns (one of which is Question #1 or #2).
•
Functional Assessment: Question #10
NOTE: Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of
social, occupational, or other important areas of functioning and ruling out normal bereavement, a history
of Manic Episode (Bipolar Disorder), and a physical disorder, medication or other drug as the biological
cause of the symptoms.
Patient Health Questionnaire (PHQ-9) Form
Provisional Diagnosis
PHQ‐9
Symptoms & Impairment
Severity
1-4 symptoms (not including questions 1 or 2),
<10
Mild or Minimal Depressive
+ functional impairment
Symptoms
2‐4 symptoms including question 1 or 2, +
10-14
Moderate Depressive Symptoms
functional impairment
(Major Depression )*
> 5 symptoms including question 1 or 2, +
15-19
Moderate Severe Major Depression
functional impairment
> 5 symptoms including question 1 or 2, +
Sever Major Depression
≥ 20
functional impairment
* If symptoms present for > 2 years, chronic depression, or functional impairment is severe, remission
with watchful waiting is unlikely. IMMEDIATE active treatment is indicated for Major Depression.
Three (3) Phases of Depression Treatment**
Acute Phase
Aims at minimizing depressive symptoms – typically first 3‐ 4
months of therapy
Continuation Phase
Tries to prevent return of symptoms in the current episode – 4-12
months (Repeat PHQ-9 Q 4-6 months).
Maintenance Phase
Tries to prevent return of symptoms within 2 years – 12-24
months
Medication Therapy is recommended for at least 9 months after return to well state.
** REFERRAL or co-management with mental health specialty clinician if the patient is:
High Suicide Risk
Bipolar Disorder
Inadequate Treatment Response
Complex Psychosocial Needs
Other Active Mental Disorder
Adopted from The MacArthur Initiative on Depression and Primary Care at Dartmouth & Duke, Version 9.0 -January 2004.
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