PHQ-9
The PHQ-9 is a nine item questionnaire used by clinicians to help them diagnose major depression and monitor a patient’s response to depression treatment*. It consists of nine questions which are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV (Diagnostic and Statistical Manual Fourth Edition) published by the American Psychiatric Association. Each symptom is scored on a 0-3 Likert Scale and scores range from 0-27.
The PHQ-9 is a particularly useful tool in the diagnosis of depression and the assessment of treatment response because it helps clinicians assess the severity of the symptoms the patient is experiencing. It also allows the clinician to determine which symptoms are improving over time with treatment and which are not.
The PHQ-9 has other advantages as well. It is shorter than many other depression rating scales. It can be administered in a variety of ways (in person, via telephone or self-administered). Furthermore, research has validated its use in a variety of patients, including adolescent and geriatric populations. It is also available in a number of languages, including Spanish.
* *The PHQ-9 is adapted from PRIMEMDTODAY, developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke , and colleagues with an educational grant from Pfizer Inc. For research information, contact Dr. Spitzer at rls@columbia.edu. The names PRIME-MD® and PRIMEMDTODAY® are trademarks of Pfizer Inc. PHQ-9 copyright ® Pfizer Inc. All rights reserved. Reproduced with permission of Pfizer, Inc. PRIMEMD® is a trademark of Pfizer Inc.
For more information about the terms of use for the PHQ9, including that “You will only use the PHQ-9 in clinical settings (i.e., in a doctor’s office or hospital as a clinical tool), for research purposes, for physician education programs, or in clinical trials”, visit the Pfizer website.
Diabetes Self-Care Activities (SDSCA)*
The SDSCA is a self-report questionnaire designed to measure the self-care behaviors of patients with diabetes. Items on the questionnaire assess a number of key behaviors in the patient’s management of their disease. These include diet, exercise, blood-glucose monitoring, foot care and smoking. Respondents indicate how often they have performed activities relating to these topics over the past seven days. Items are measured individually and not used to create an overall self-care score.
The SDSCA was created by researchers at the Oregon Research Institute to address a need for a reliable, non-judgmental measure of patients’ self-care behaviors. Research on the measure indicates that the questionnaire is generalizable to various groups of patients with diabetes across gender, age, number of comorbid medical illnesses and duration of diabetes.
* Toobert et al. The Summary of Diabetes Self-Care Activities Measure. Diabetes Care, 23(7) July 2000: 943-950.
The Symptom Checklist *
PATHWAYS researchers used the 20 item depression symptom scale of The Symptom Checklist-90 to measure change in depression over the course of treatment in the intervention and usual care arms of the study. Patients’ response to treatment was measured at 6 and 12 months using this tool.
The SCL-20 item depression scale has been demonstrated in numerous studies to have high reliability and validity. It has been used successfully across age ranges and genders in a variety of mental health settings. Clinicians and researcher use this tool to measure both initial symptoms and patients’ progress with treatment. The SCL-20 has been found to be as or more sensitive to change than other commonly used depression scales such as the Hamilton, PHQ-9 or Beck.
* Derogatis L, et al. The Hopkins Symptom Checklist: a measure of primary symptom dimensions. In: Pichot P, ed. Psychological Measurement in Psychopharmacology: Problems in Psychopharmacology. Basel, Switzerland: Kargerman; 1974:79-110.
Problem Solving Treatment
Problem-Solving Treatment (PST) is a brief form of evidence-based psychotherapy. It focuses on teaching people to solve the everyday problems that contribute to their depression by setting small, achievable goals and building self-efficacy. It is a short-term treatment, generally lasting 6-10 sessions. The usefulness of PST has been widely studied and it has been found highly effective in treating patients with depression in a variety of settings.
Practitioners interested in more information and/or formal training in the techniques of PST should visit the PST information section of the Project IMPACT website.
IMPACT is a research project studying collaborative care for depression in older adults and is closely related to the PATHWAYS study.
Diabetes Complications Severity Index (DCSI) *
PATHWAYS researchers developed the Diabetes Complications Severity Index (DCSI) as a tool to help health care organizations target limited resources to invest in creating disease management interventions for patients with diabetes at highest risk of adverse medical outcomes. This instrument measures the severity of diabetes complications based on automated data and was shown to significantly predict the risk for hospitalization and mortality in the subsequent year. The DCSI can also be used as a case mix adjuster in comparing populations of diabetes patients. Seven categories of complications are included:
- Cardiovascular disease
- Kidney disease
- Retinal disease/blindness
- Peripheral vascular disease
- Stroke
- Neuropathy
- Metabolic problems
Each complication is scored on a scale of 0 – 2 (inclusive), where 0 = no abnormality, 1 = some abnormality, and 2 = severe abnormality.
Through statistical analysis and comparisons with other methods, the DCSI was shown to be a useful tool for physicians and patients in providing a snapshot of the patients’ diabetes complications at any given time. It will help physicians and health care organizations predict the risk of mortality and hospitalizations.
* Young et al. Diabetes Complications Severity Index and Risk of Mortality, Hospitalization, and Healthcare Utilization. American Journal of Managed Care 2008; 14:15-23.