| Step 1a: Red flags: |
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Does the patient present with any of the following?
- History of depression
- Multiple unexplained somatic symptoms
- Recent major stressor or loss
- High healthcare utilizer
- Chronic pain
- Chronic illness(es)
- Chief complaint of sleep disturbance, fatigue, appetite or weight change
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| STEP 1b: Ask screening questions |
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Whenever you suspect depression, ask the patient these questions:
During the past month:
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1. Have you often been bothered by little interest or pleasure in doing things?
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2. Feeling down, depressed or hopeless?
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If patient says “yes" to either of these questions, use the PHQ-9 to assist with diagnostic assessment.
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STEP 1c: Complete diagnostic assessment & administer the diagnostic assessment tool
(PHQ-9) at the initial visit
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Clinicians should follow their usual diagnostic assessment. In addition, the PHQ-9 is a patient self-administered questionnaire that helps make a depression diagnosis and determine severity. The clinician and/or office staff discusses the reasons for completing the questionnaire and explains how to fill it out.
After the patient has completed the PHQ-9 questionnaire, it is scored by the clinician or office staff. There are two components on the PHQ-9 to be tallied:
• Number of symptoms (Follows DSM-IV criteria for depression)
• Total severity score (Depression severity)
In addition, the patient will rate the level of functional impairment (impact on their life).
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| STEP 1d: Assessing suicide risk
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If the suicide item is positive on the PHQ-9 (question “i”), the clinician needs to perform a
suicide risk assessment.
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| STEP 1e: Formulating a depression diagnosis
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Based on the PHQ-9 number of symptoms present more than half the days in the past 2 weeks,
the total severity score, and the level of functional impairment, the clinician can formulate a
working depression diagnosis.
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