CCP Depression Screening & PHQ-9 3 — Questions and Answers
Question 1: In patients with chronic medical conditions, PHQ-9 somatic items (sleep, fatigue, appetite) may inflate scores due to the underlying disease. What is one recommended approach?
- Use only the cognitive/affective items (PHQ-9A)
- Exclude all somatic questions from scoring
- Apply the standard scoring unchanged, using clinical judgment for interpretation (Correct answer)
- Switch to the BDI-II for all medically ill patients
Correct answer: Apply the standard scoring unchanged, using clinical judgment for interpretation
Most experts recommend using standard PHQ-9 scoring in medically ill patients while applying clinical judgment, rather than excluding somatic items.
Question 2: What is the PHQ-2, and when is it typically used?
- A 2-question version used as an initial screening tool before administering the full PHQ-9 (Correct answer)
- A version of the PHQ-9 validated only in post-partum women
- A pediatric depression scale for ages 2–12
- A 2-week follow-up tool after PHQ-9 baseline
Correct answer: A 2-question version used as an initial screening tool before administering the full PHQ-9
The PHQ-2 consists of the first two PHQ-9 items and is used as a brief initial screen; a score of ≥3 triggers administration of the full PHQ-9.
Question 3: Which of the following populations was the PHQ-9 originally validated in?
- Psychiatric inpatients
- Primary care and obstetrics patients (Correct answer)
- Adolescents aged 12–17
- Long-term care residents
Correct answer: Primary care and obstetrics patients
Kroenke, Spitzer, and Williams validated the PHQ-9 in primary care and obstetrics clinic patients in their landmark 2001 study.
Question 4: The PHQ-A is a version of the PHQ-9 adapted for which group?
- Adults over 65
- Adolescents aged 12–17 (Correct answer)
- Patients with diabetes
- Patients on dialysis
Correct answer: Adolescents aged 12–17
The PHQ-A (Adolescent) modifies language for adolescents and has been validated for ages 12–17.
Question 5: A 72-year-old patient with heart failure scores 8 on the PHQ-9. What is the most appropriate next step?
- No action needed; this is a normal finding in elderly cardiac patients
- Reassess in 4–6 weeks and consider watchful waiting with supportive counseling (Correct answer)
- Immediately refer to emergency psychiatry
- Initiate SSRI therapy without further evaluation
Correct answer: Reassess in 4–6 weeks and consider watchful waiting with supportive counseling
A score of 5–9 (mild depression) warrants watchful waiting, patient education, and follow-up reassessment rather than immediate pharmacotherapy or emergency referral.
Question 6: Which chronic disease comorbidity is associated with the highest prevalence of comorbid depression, making PHQ-9 screening especially critical?
- Hypertension
- Diabetes mellitus (Correct answer)
- Hyperlipidemia
- Osteoarthritis
Correct answer: Diabetes mellitus
Depression affects approximately 15–25% of people with diabetes, nearly double the general population rate, creating bidirectional adverse effects on outcomes.
Question 7: For patients with limited English proficiency, which statement about PHQ-9 use is most accurate?
- The PHQ-9 has only been validated in English and should not be used in other languages
- Validated translations exist in over 30 languages and should be used when available (Correct answer)
- An interpreter reading the English version aloud is considered equivalent to a validated translation
- Only the PHQ-2 is available in non-English languages
Correct answer: Validated translations exist in over 30 languages and should be used when available
The PHQ-9 has been translated and validated in more than 30 languages, and using the validated translated version is preferred over interpreter-mediated English administration.
CCP Depression Screening & PHQ-9 3
In patients with chronic medical conditions, PHQ-9 somatic items (sleep, fatigue, appetite) may inflate scores due to the underlying disease.
What is one recommended approach?