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