What is the PHQ-9? The Patient Health Questionnaire Nine (PHQ-9) is a 9-item questionnaire for assessing depressive symptoms and their severity. Each of the nine items corresponds with a DSM-5 criterion for depression. Download here Why use the PHQ-9? Validated for people with diabetes Quick to administer, easy to score and interpret Freely available in more than 40 languages. When to use the PHQ-9 For further assessment if a person is experiencing depressive symptoms To start a dialogue with the person about depressive symptoms For systematic monitoring of depressive symptoms over time. How to use the PHQ-9 The person with diabetes indicates how frequently they experience each of the nine items by scoring each item on a scale from 0 (not at all) to 3 (nearly every day). The scores from each item are summed to generate a total score (range: 0–27). How to interpret the scores 0–4: None to minimal depressive symptoms 5–9: Mild depressive symptoms 10–27: Moderate to severe depressive symptoms. What to do with the score A total score of 10 or more is an indicator of likely depression and needs to be followed up with a clinical interview. For people with diabetes in specialised clinics (usually those with severe complications), a cut-off value of 12 or more has been recommended due to the overlap between symptoms of depression and diabetes. For older people with diabetes in general practice, a cut-off of 7 or more has been recommended. If a person scores 1 or more on item 9 (referring to suicidal ideation), further assessment for risk of suicide or self-harm is required, irrespective of total score. Referral considerations Neither mild nor major depression is likely to improve spontaneously, so intervention is important. The stepped care approach provides guidance on how to address depressive symptoms and depression in clinical practice. If a person is actively suicidal, provide or arrange continuous supervision. Keep in mind that some individuals may decide not to share their suicide plans and deny they have suicidal thoughts. The decision about whether to refer for additional mental health support depends on the person’s needs and preferences, the severity of their symptoms, and whether you feel you have the knowledge, qualifications and capacity to offer an appropriate level of support. Alternatives to PHQ-9 The PHQ-2 is a short version of the PHQ-9 and contains item 1, ‘little interest or pleasure in doing things’, and item 2, ‘feeling down, depressed or hopeless’. A total score of 3 or more indicates further assessment for depression. For Aboriginal or Torres Strait Islander people, three alternative versions of the PHQ-9 have been developed, but only two have been validated. For more information about using depression questionnaires with Aboriginal and Torres Straight Islander people, see Chapter 1 in Diabetes and emotional health: a practical guide for health professionals supporting adults with type 1 or type 2 diabetes. Also consider Collaborative care with mental health professionals experienced in diabetes care to provide comprehensive and tailored support for the person experiencing mental health challenges. Clear communication between primary care providers and mental health professionals. If the person is not ready for referral to a mental health professional, gently explore and address any concerns they may have, and let them know they have time to think about what support options are best for them.
