Depression Screening Tools

by India Carson

As we enter the sixth month of the coronavirus (COVID-19) epidemic, many of us are feeling the stressfulness of this situation.  Public health recommendations, such as social distancing, can make us feel isolated and lonely, increasing the feelings of stress and anxiety.  Many people are experiencing financial hardship as many businesses have closed.  Some people are even experiencing homelessness as evictions have begun.

Primary care providers have an increasingly important role in identifying those patients who are depressed.   And while anxiety and fear may be normal responses during this time, it is important to identify those who are at a greater risk for suicidality.  Among the people who die by suicide, 83% have seen a primary care provider in the previous year and 50% have visited a PCP within 30 days of their death.  Hopelessness is often the leading motivation for completed suicide, making this a primary time to screen for depression.

The Patient Health Questionnaire-2 (PHQ-2) is a two-item screening tool for depression.  This is widely used in the primary care practice setting.  The PHS-2 asks about the frequency of depressed mood over the past two weeks.  The purpose is to screen for depression as a first step.  It asks:

 If the score is 3 or greater, further evaluation with the PHQ-9 is needed to determine if the patient meets criteria for a depressive disorder.  This includes the previous two questions, plus an additional seven:

 Scores indicate the following:

0 – 4  None or minimal depression.

5 – 9  Mild depression – Watchful waiting; repeat PHQ-9 at follow-up visit.

10 – 14 Moderate depression – Treatment plan, considering counseling, follow-up and/or pharmacotherapy.

15 – 19 Moderately severe depression – Active treatment with pharmacotherapy and/or psychotherapy.

20 – 27 Severe depression – Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management.

At Chordline Health, we include these PHQ-2 questions in our HRA (Health Risk Assessment).  We also have the follow-up PHQ-9 for screening members for depression since we believe that helping you to help your members as they navigate this crisis is imperative.

¹ Role of Primary Care in Suicide Prevention During the COVID-19 Pandemic.  The Journal for Nurse Practitioners.  Nelson, Pamela Anne and Adams, Susie M.  July 19, 2020   Retrieved September 4, 2020 from https://www.npjournal.org/article/S1555-4155(20)30395-0/fulltext