The evaluation tool PHQ-9 is a nine-item depression module used to validate the severity of depression in patients, and it is a valuable tool when making an appropriate assessment in conducting treatment decisions. This Patient Health Questionnaire (PHQ) is necessary for adolescent patient population since this category of young adults are continually experiencing multiple physical, emotional, psychological and social changes simultaneously. Such ordeals are liable to be accompanied by their fair share of mood swings and confusion that can bring about mental conflict if not taken care of appropriately. Adolescents are prone to feel stressed out and disappointed in the unrealistic expectation placed upon by their peers in academic and social realms. This feeling of disconnection has the potential to manifest itself into a depressive state in which the victim results in acts of harm against one’s body or other people surrounding him/her. The PHQ-9 serves as a detecting mechanism that allows the individual to measure his or her susceptibility to depression, and it is through this early detection that rehabilitation is easily implemented.
The PHQ-9 has been extensively used to determine depression among adults, and this method has rarely disappointed in producing results. When it comes to testing adolescents, we find that compared to structured interviews, PHQ-9 had a higher sensitivity of 89.5% and an excellent specificity of 78.8% when measuring major depression in the adolescent population. The PHQ-9 as a screening tool is more efficient in adults than in adolescences since its sensitivity is higher than the specificity in the teenagers, this means only the adolescent population with severe depression will be identified by this method (Richardson et al., 2010). Therefore, its validity is challenged by this fact, but still, the process has proven reliable in the identification of severe depression among teenagers.
In a clinical setting in India 233 adolescents age 14-18 were tested for depression using PHQ-9, the results tallied 13.3% had a case of distress in a regular interview, but the PHQ-9 revealed a figure higher than 50% in a 100% threshold. Therefore, this tool is psychometrically sound for pediatricians to use in primary care as it produced more accurate results than a conventional interview. It is short and easy to answer therefore it is the best option for a developing country to use in the identification of depression in adolescents, as it is reliable in providing accurate information (Ganguly et al., 2013).
The clinical practice of providing evidence-based depression management among adolescents was conducted on Asian-Americans to figure out the high prevalence rate of depression among the community. The study revealed a moderate rate of sadness for the young adult age group and treatment was offered to those who showed severe cases of depression. The PHQ-9 was efficient in assessing depression consistently and was sought out as most useful while dealing with large populations, therefore, proving that the method was valid and reliable (Chen et al., 2006).
Applying PHQ-9 to a patient situation, the following are the results of the questionnaire;
- Lack of interest and pleasure in performing? More than half the days
- Feeling hopeless? Several days.
- Trouble falling asleep or sleeping too much? Several days.
- Feeling tired or having little energy? More than half the days.
- Poor appetite or overeating? Several days.
- Feeling bad about yourself? Not at all.
- Trouble concentrating on minor things, such as reading the newspaper or watching television? More than half the days.
- Moving and speaking so slowly that other people could have noticed? Not at all.
Alternatively, being so fidgety or restless that you have been moving around a lot more than usual? Several days.
- Thoughts of hurting yourself in some way? Not at all.
The patient in the study above scored a 19/27, which is considered moderately severe. Any PHQ-9 score above or equal to 10 is sensitive to 88% and specific to 88%, which is significant depression. The patient in this scenario should enroll in a rehabilitation program particular to depression and carry out regular checkups to assess the improvement rate of his condition. In addition to this, the patient should keep off depressive situations before taking prescription medication to tackle depression (Pinto-Meza et al., 2005).
- Chen, T. M., Huang, F. Y., Chang, C., & Chung, H. (2006). Using the PHQ-9 for depression screening and treatment monitoring for Chinese Americans in primary care. Psychiatric services, 57(7), 976-981.
- Ganguly, S., Samanta, M., Roy, P., Chatterjee, S., Kaplan, D. W., & Basu, B. (2013). Patient health questionnaire-9 as an effective tool for screening of depression among Indian adolescents. Journal of Adolescent Health, 52(5), 546-551.
- Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, et al; Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone? J Gen Intern Med. 2005 Aug 20(8):738-42
- Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., … & Katon, W. (2010). Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents.Pediatrics, 126(6), 1117-1123.