PHQ 2

What is major depressive disorder (MDD)?

Major depressive disorder (MDD) is a serious mental health condition characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities once enjoyed (American Psychiatric Association, 2013). It is one of the most common mental health disorders, but if left unaddressed, a client's depressed mood and other symptoms can significantly impact an individual's ability to function in daily life.

MDD is more than just feeling "blue" or experiencing temporary emotional ups and downs. It is a clinical disorder described in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) that affects a person's mood, thoughts, behavior, and physical well-being. Individuals with MDD may experience a variety of symptoms, including:

• Persistent feelings of sadness, emptiness, or hopelessness
• Loss of interest or pleasure in activities once enjoyed
• Significant weight loss or gain (without dieting)
• Sleep disturbances (insomnia or excessive sleeping)
• Fatigue or lack of energy
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating or making decisions
• Recurrent thoughts of death or suicide

The severity, frequency, and duration of these symptoms can vary from person to person, but they must be present most of the day, nearly every day, for at least the past two weeks to be diagnosed with MDD (World Health Organization, 2023).

How do you diagnose major depressive disorder (MDD)?

Detecting major depression and other depressive disorders typically involves a comprehensive evaluation by a qualified mental health professional, such as a psychiatrist, psychologist, or licensed clinical social worker. The process usually involves the following steps:

1. Clinical interview: The healthcare provider will conduct a detailed interview to assess the individual's symptoms, duration, severity, and impact on daily functioning. They will ask about the person's mood, sleep patterns, energy levels, appetite, and ability to concentrate, among other factors.
2. Screening tools: Healthcare providers may use standardized screening tools, such as the Patient Health Questionnaire (PHQ-9) or the Beck Depression Inventory (BDI), to help evaluate the presence and severity of depressive symptoms (Kroenke et al., 2001).
3. Physical examination: A physical exam may be performed to rule out any underlying medical conditions contributing to the symptoms.
4. Review of medical history: The healthcare provider will review the individual's medical history, including any previous mental health conditions, medications, and potential risk factors for depression.
5. Diagnostic criteria: The healthcare provider will use the requirements outlined in the DSM-5 to determine if the individual meets the diagnostic criteria for MDD (American Psychiatric Association, 2013).

It's important to note that no single test can definitively diagnose and identify major depression. The diagnosis is based on the therapist's clinical judgment and comprehensive evaluation of the individual's symptoms, medical history, and overall functioning (Siu et al., 2016).

What is the Patient Health Questionnaire-2 (PHQ-2)?

The Patient Health Questionnaire 2 (PHQ-2) is a brief depression severity measure used to identify individuals who may be experiencing symptoms of depression. It consists of two simple questions that assess the core symptoms of depression: low mood and lack of interest or pleasure in activities.

The two questions in the PHQ-2 are:

1. Over the last two weeks, how often have you been bothered by little interest or pleasure in doing things?
2. Over the last two weeks, how often have you been bothered by feeling down, depressed, or hopeless?

The PHQ-2 is widely used in primary care settings, as it is a quick and efficient way to identify individuals who may be experiencing depression and require additional assessment or treatment. It is a valuable tool for healthcare practitioners to identify potential cases of depression early and provide appropriate care or referrals.

How to use the Patient Health Questionnaire-2 (PHQ-2)

Here's a step-by-step guide on how healthcare practitioners can use the PHQ-2 in their practice:

Step 1: Administer the PHQ-2

Administer the PHQ-2 to patients during routine visits or when depression is suspected. The two questions can be asked verbally or given as a written questionnaire.

Step 2: Score the responses

Score the PHQ-2 by summing the responses to the two questions, scoring each on a scale from 0 (not at all) to 3 (nearly every day).

Step 3: Interpret the score

To interpret the PHQ-2 score, a score of 0-2 means a low risk of depression; no further evaluation is needed. A score of 3 or higher means that clients screen positive for depression. If this happens, proceed to step 4.  

Step 4: Conduct further evaluation

For patients with a positive screen (score ≥3), administer the more comprehensive Patient Health Questionnaire 9 (PHQ-9) or conduct a diagnostic interview further to evaluate the presence and severity of depressive symptoms.

Step 5: Develop a treatment plan

Based on the PHQ-9 score or diagnostic interview, develop an appropriate mental health treatment plan, including referral to a professional, initiation of therapy, medication management, or a combination of these interventions.

PHQ-2 scoring and interpretation

The PHQ-2 is a simple and effective tool for screening patients for depression. The PHQ-2 consists of two questions, each scored on a scale from 0 to 3:

• 0: Not at all
• 1: Several days
• 2: More than half the days
• 3: Nearly every day

Then, add the scores for the two questions to get a total score ranging from 0 to 6. A score of 0-2 is considered negative for depression. Therefore, no further evaluation is needed. On the other hand, a score of 3 or higher is regarded as a positive screen for depression.

A positive PHQ-2 screen does not necessarily mean the patient has clinical depression. It indicates that further evaluation is warranted using a more comprehensive tool like the PHQ-9 or a diagnostic interview (Kroenke et al., 2003).

The higher the PHQ-2 score, the greater the likelihood of depression being present. However, even a score of 3 should prompt further assessment, as depression can be a serious condition with significant impacts on a patient's well-being and quality of life.

It's important to remember that this two-item depression screener, along with other patient health questionnaires, are screening tools, not diagnostic instruments. A positive screen should be followed up with additional evaluation and appropriate treatment or referral if depression is confirmed.

Benefits of using the Patient Health Questionnaire-2 (PHQ-2)

Using the PHQ-2 in clinical practice offers several benefits for healthcare practitioners:

Rapid screening

The PHQ-2 is a brief, two-question tool that can quickly identify individuals who may be experiencing symptoms of depression. This allows for efficient screening during routine visits or when depression is suspected.

Early detection

By incorporating the PHQ-2 into regular patient assessments, healthcare practitioners can identify potential cases of depression early, before symptoms become more severe or chronic.

Improved patient-provider communication

Administering the PHQ-2 can open the door for conversations about mental health, allowing patients to feel more comfortable discussing their emotional well-being with their healthcare providers, such as family physicians or other healthcare specialists.

Facilitates further evaluation

A positive PHQ-2 score indicates the need for further evaluation using more comprehensive tools like the PHQ-9 or a diagnostic interview. This streamlines the process of identifying individuals who require additional assessment and potential treatment for depression.

Increased awareness

Incorporating the PHQ-2 into routine practice can help raise awareness about depression and promote regular screening, which can lead to improved patient outcomes and better management of this common mental health condition.

Evidence-based

The PHQ-2 is a well-validated and widely-used screening tool, with numerous studies supporting its reliability and validity in various healthcare settings.

By using the PHQ-2, healthcare practitioners can effectively screen for depression, promote early intervention, and provide appropriate care or referrals for individuals who may be struggling with this condition.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Pearson.

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care, 41(11), 1284–1292. https://doi.org/10.1097/01.MLR.0000093487.78664.3C

Siu, A. L., US Preventive Services Task Force (USPSTF), Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., García, F. A., Gillman, M., Herzstein, J., Kemper, A. R., Krist, A. H., Kurth, A. E., Owens, D. K., Phillips, W. R., Phipps, M. G., & Pignone, M. P. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. Journal of the American Medical Association, 315(4), 380–387. https://doi.org/10.1001/jama.2015.18392

World Health Organization. (2023, March 31). Depressive disorder (depression). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depression