PHQ-9 and GAD-7

PHQ-9

• the origin of PHQ-9 begins with the creation of the Primary Care Evaluation of Mental Disorders (PRIME-MD)
• the original PRIME-MD was created in mid 1990s under the sponsorship of Pfizer, a popular pharmaceutical company in America
  • it assessed 19 mental disorders, grouped into the 5 (depression, anxiety, somatoform disorders, alcohol use disorders, eating disorders) using a series of yes or no questions about the presence of symptoms during the last month
  • Although it covered an extensive list of disorders, there were several cons. A clinician had to score their tests and do a follow-up interview using a Clinical Evaluation Guide (CEG) before a formal diagnosis. The involvement of clinicians and the long administration time undercut PRIME-MD;s widespread utility.
• PHQ
  • developed because of the average administration time (8 minutes) is too long in a clinical setting, where consultations usually last for about 15 minutes
  • combines 2 components of PRIME-MD: patient questionnaire and clinical evaluation guide
  • only assesses 8 disorders by grouping 18 mental disorders into some of the mood, anxiety, and somatoform disorders together
  • 4th page includes questions about menstruation, pregnancy, childbirth, and recent psychosocial stressors
  • modification in depression scale: prevalence of depression symptoms under DSM-IV was asked
  • large-scale testing: 3,000 from general internal medicine and family medicine clinics and another 3, 000 from obstetrics-gynecology clinics
  • PHQ-9: gained popularity and increasing usage in clinical settings to diagnose depression and its severity

Purpose (Objective, Object, and Examinee)

Objective and Object

• assesses if patient qualifies for depression
  • based on DSM-IV criteria
• given after PHQ-2
  • PHQ-2 screens depression
  • positive results in PHQ entail answering PHQ-9
• monitoring details
  • symptom severity
  • response to treatment

Examinee

• those with positive results from PHQ-2
• at-risk population or predisposed people, such as those with
  • cardiac disease
  • stroke (suffered from)
  • diabetes
• geriatrics
• primary care patients

Administration (The Test Proper and its Process)

• Administrator
  • can be any trusted staff member, for it is actually usually given to the patient to answer in the waiting room
  • monitor and guided by an expert to ensure that the person who administers it is comfortable with interacting with the patient especially with number 9
• Patient
  • appropriate for 12 years and older, pregnant and postpartum women, as they are generally more aware of their emotions or are the most vulnerable
  • a patient’s answers in PHQ-2 will determine if the PHQ-9 is necessary to be administered
• Setting
  • usually in the waiting room of a clinic
• Duration
  • takes approximately 4 minutes
• Purpose of Re-Administration
  • actual expert or clinician will be the one adminsitering
  • to check if the symptoms are indeed consistent and pervasive = to fortify the need for diagnosis

Scoring and Interpretation (For Diagnosis and Possible Recommendations)

• total score is obtained by adding up all checked boxes
• for every check in
  • not at all = 0 points
  • several days = 1 point
  • more than half the days = 2 points
  • nearly every day = 3 points
• consider MDD if
  • there are at least 5 checks in the shaded section
• consider other repressive disorder if
  • there are at least 2 to 4 checks in the shaded section
• diagnosis of above mentioned disorders also require impairment of important areas of functioning
  • corresponds to question # 10

Note: Question 9 is a single screening question on suicide risk. A patient who answers yes to question 9 needs further assessment for suicide risk by an individual who is competent to assess this risk.

• last item is not included in score, but is a good indicator of the patient’s global impairment and can be used to track treatment response
• higher PHQ-9 scores are associated with decreased functional status and increased symptom-related difficulties, sick days, and healthcare utilization
• may have false positive rates in primary care settings specifically

GAD-7 (General Anxiety Disorder - 7)

History

• originally started with 13 items based on the criteria for GAD in the DSM-IV, 9 items from DSM-IV and 4 from reviewing existing anxiety scales 7 items with the highest correlation with the total 13-item scale score became the final items
• developed by Robert L. Spitzer, MD, Kurt Kroenke, MD, Janet B.W. Williams, DSW, and Bernd Low, MD, PhD
• the original results of the developers testing the GAD-7 reported that “GAD-7 had good reliability, as well as criterion, construct, factorial, and procedural validity”
• also used in other anxiety disorders
• developed as a screener for generalized anxiety disorder (GAD) in primary care settings
• now, it uses some of the DSM-V criteria for GAD
• can also be used as a screening measure of panic, social anxiety, and PTSD

Purpose

• rapid screening for the presence of a clinically significant anxiety disorder
• symptom severity measure for the 4 most common anxiety disorders
  • moderately good at screening 3 other common anxiety disorders
  • although it may be used as an indicator of other anxiety disorders, GAD-7 specializes in and focuses on assessing mainly GAD
• one of the most frequently used for screening, diagnosis, and severity assessment of anxiety disorder

Administration

• self-administered by the patient (preferred)
• by interviewer in person or via telephone
• takes 2 to 5 minutes to complete
• done in the waiting area prior to session, closed session, and/or at home prior to appointment
• collected using paper and pencil, software, tablets or other electronic device

Scoring

• higher GAD-7 scores correlate with a disability and functional impairment
• calculated by summing up the scores of 0, 1, 2, and 3 from the response categories
  • 0-4: minimal
  • 5-9: mild
  • 10-14: moderate
  • 15-21: severe
• higher score = greater anxiety; scores above 10 are considered to be in the clinical range
• further evaluation is recommended when the score is 10 or greater