Concordance between PHQ-9 scores and patients' experiences of depression: a mixed methods study.
BACKGROUND
In 2009, a new indicator (DEP 3) was introduced into the Quality and Outcomes Framework. GPs are now encouraged to assess response to antidepressant treatment 5-12 weeks after the initial assessment, to guide clinical decision making. The Patient Health Questionnaire (PHQ-9) is one of the validated instruments that GPs can use to assess the patient's clinical state.


OBJECTIVE
To explore the extent to which changes in PHQ-9 score over time reflect patients' accounts of their experiences of depression during the same period; and to explore patients' experiences of using the PHQ-9 within primary care consultations.


METHODS
Mixed methods.


METHODS
Primary care.


METHODS
Patients were recruited through six GP practices. The PHQ-9 and in-depth interviews were used at the same three time points over a 6-month period during a new or first episode of depression.


RESULTS
Patterns in the total PHQ-9 score broadly reflected patients' accounts of the severity of their depression over time. However, the PHQ-9 was inaccurate in its assessment of the presence and intensity of thoughts of self-harm, and missed symptoms that are meaningful to patients. At the diagnostic primary care consultation, patients viewed their score as a 'tangible' measure of their condition. Some patients requested the PHQ-9 subsequently as a way to measure their own treatment response and recovery process.


CONCLUSIONS
The potential therapeutic value of the PHQ-9 may be dependent upon the GP's willingness to openly discuss the results and what they may mean for the patient.
University of Bristol, Academic Unit of Primary Care, 25-27 Belgrave Road, Clifton, Bristol BS8 2AAA. A.malpass@bristol.ac.uk
Alice
A
Malpass
Alison
A
Shaw
David
D
Kessler
Deborah
D
Sharp
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003657:Decision Making; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
D000928:Antidepressive Agents