Use of the Patient Health Questionnaire (PHQ-9) in Practice: Interactions between patients and physicians

Abstract

We analyze the use of nine-item Patient Health Questionnaire (PHQ-9), an instrument that is widely used in diagnosing and determining the severity of depression. Using conversation analysis, we show how the doctor deploys the PHQ-9 in response to the patient’s doubts about whether she is depressed. Rather than relaying the PHQ-9 verbatim, the doctor deviates from the wording so that the response options are selectively offered to upgrade the severity of the patient’s symptoms. This works in favor of a positive diagnosis and is used to justify a treatment recommendation that the patient previously resisted. This contrasted with the rest of the data set, where diagnosis was either not delivered (as patients are presenting with ongoing problems) or delivered without using the PHQ-9. When clinician-administered, the PHQ-9 can be influenced by how response items are presented. This can lead to either downgrading or upgrading the severity of depression.

Impact of coronavirus disease 2019 on patients with chronic pain: multicenter study in Korea

“…A method based on a cut-off score of 10 or more was used to screen for major depressive disorders. A 10th item was added to the diagnosis section of the PHQ-9 to ask the patient how difficult it was to manage their work, housework, and interpersonal relationships [ 16 – 21 ].…”

A direct observation of pain scale use in five video-recorded palliative care consultations: Using conversation analysis to show how practitioners support patients to describe pain

“…Firstly, as with other standardised assessment tools [6] , [7] , practitioners may diverge from standardised delivery of the pain scale. We demonstrate good clinical justification for this: if patients demonstrate understanding and begin to answer, continuing to explain the pain scale would come across as confrontational or patronising.…”

“…Use of pain scales warrants further examination for two reasons. Firstly, studies of other standardised assessments show that formal guidance and actual practice diverge in ways that impact the way patients respond [6] , [7] . Secondly, patients with advanced disease describe pain’s complex impact on performing everyday tasks and maintaining relationships with loved ones [8] , [9] .…”

Depression prediction using machine learning: a review

“…The PHQ [36], [37] is a multipurpose method for screening, tracking, diagnosing, and measuring depression severity. It is a self-administered instrument with two distinct types, the PHQ-2 containing two items and the PHQ-9 containing nine items.…”