title: Physician actions following a positive PHQ-2: implications for the implementation of depression screening in family medicine practice.
abstract: Systematic screening of depression in primary care settings that have adequate follow-up and treatment is recommended. The Patient Health Questionnaire (PHQ-9) was developed as a depression screening measure for use in primary care. The PHQ-2, which includes just 2 items from the PHQ-9, is designed to be used as a first line depression screening measure, to be followed by the full PHQ-9 when a patient screens positive. However, completion of the first step in the process (PHQ-2) does not necessarily lead to completion of the second step (administration of the PHQ-9 when the PHQ-2 is positive), even when treatment and follow-up are available. The objective of the current study was to describe family medicine physicians' actions following a positive PHQ-2 and factors that affect their use of depression screening measures and treatment decisions. A retrospective chart review of 200 family medicine patients who screened positive on the PHQ-2 during an office visit was conducted. Additionally, 26 family medicine physicians in the practice were surveyed. Only 5% of patients with positive PHQ-2 scores were administered a PHQ-9. Physicians relied on their clinical judgment and prior knowledge about the patient's depression status to inform treatment decisions and cited time constraints and competing demands as reasons for not administered the PHQ-9. Physicians tended to treat depression with adequate doses of antidepressants and counseling. PHQ-2 screening did not necessarily lead to further evaluation, systematic follow-up, or changes in treatment. Implications for the implementation of depression screening in primary care settings are discussed.
authors.affiliation: Department of Psychiatry and Human Behavior.
authors.forename: Cara H
authors.initials: CH
authors.lastname: Fuchs
authors.affiliation: Psychosocial Research, Butler Hospital.
authors.forename: Natasha
authors.initials: N
authors.lastname: Haradhvala
authors.affiliation: Department of Psychiatry and Human Behavior.
authors.forename: Samuel
authors.initials: S
authors.lastname: Hubley
authors.affiliation: Department of Psychiatry and Human Behavior.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Nash
authors.affiliation: Department of Psychiatry and Human Behavior.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
authors.affiliation: Department of Family Medicine.
authors.forename: David
authors.initials: D
authors.lastname: Ashley
authors.affiliation: Department of Psychiatry and Human Behavior.
authors.forename: Risa B
authors.initials: RB
authors.lastname: Weisberg
authors.affiliation: Department of Psychiatry and Human Behavior.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Uebelacker
mesh_terms: D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D005194:Family Practice / Q000379:methods*; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D011594:Psychometrics; D012189:Retrospective Studies; D011795:Surveys and Questionnaires