Depression is a mood disorder affecting the way an individual feels, thinks, behaves and can affect social and occupational functioning (Canadian Medical Association CMA, 2013). Public Health Agency of Canada (PHAC), 2002 reports approximately 8% of Canadian adults will experience major depression at some time in their lives and that it is the leading cause of years lived with disability worldwide. The Patient Health Questionnaire-9 (PHQ-9) was chosen for this critique to improve knowledge and understanding of this tool for practicing and new clinicians working in Primary Care. The goal is to increase confidence in utilizing the PHQ-9, increase diagnostic and monitoring accuracy, and ultimately to improve health outcomes.
Description of Tool
The PHQ-9 is a widely utilized tool in Primary Care to assist clinicians with the detection, diagnosing, monitoring, and measuring of severity of depression in adults (Kroenke, Spitzer, Williams 2001). It is a nine item self-administered questionnaire based on the Diagnostic Statistic Manual IV (DSM-IV) criteria for diagnosing depression in adults. There is a tenth question at the end regarding effect, if any, on functioning. It has also been used in many medical specialty populations for adults presenting with, or suspicion of depressive symptoms. It may be completed in clinic by the patient and takes two to five minutes (Nease et al. 2003). It is reviewed by the clinician and interpretation of the score is made using the algorithm that accompanies the questionnaire in 1-3 minutes. The expense of the paper is the only cost. The training is simply the clinician becoming familiar with the questions and the scoring.
The PHQ-9 is a version of the orig...
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...ion and diagnosis of depression but does not negate the need for clinician interview and assessment. Gilbert et. al 2007 cautioned that screening procedures alone will not improve client outcomes. One bias is that much of the research regarding the PHQ-9 has been by the developers of the tool and funded by Pfizer, however in view of several other studies supporting that it is evidence- based, this is not an ethical concern.
Overall the PHQ-9 has been shown to have a positive effect on health outcomes by aiding clinicians in detection, diagnosing and monitoring depression with a consistent reliable tool. The scope of advanced practice nursing has increased over the last decade and mental health has become a common reason to see a healthcare professional. Nurse practitioners can feel confident in using this tool as an adjunct to their clinical assessment skills.
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