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Appendix 3 Interpretation of results of outcome measures
PHQ-9
The PHQ-9 survey comprises nine questions which the patient rates, based on their experience over the past fortnight. The answers are scored from 0 to 3 and a total score of 27 is aggregated.
Patients with a PHQ of 0-5 can be considered clinically 'well' i.e. free from significant depressive symptoms and functioning as ususal.
A drop of 5 points on the PHQ scale would be considered to be clinically significant on the 0 to 27 point PHQ-9 scale. The following guidance is reported
with the PHQ (see http://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9/ for more information)
| PHQ score | Interpretation |
|---|
| 0-9 | Adjustment disorder/mild depression |
| 10-14 | Mild depression |
| 15-19 | Moderate/severe depression |
| > 20 | Severe depression |
Initial Response after 4-6 weeks of an Adequate Dose of an Antidepressant
PHQ-9 Score | Treatment Response | Treatment Plan |
|---|
Drop of = 5 points from baseline | Adequate | No treatment change needed Follow-up in 4 weeks |
Drop of 2-4 points from baseline | Probably Inadequate | Often warrants an increase in antidepressant dose |
Drop of 1 point or no change or increase | Inadequate | Increase dose: Augmentation;Switch; Informal or formal psychiatric consultation; Add psychological counselling |
Initial Response to Psychological Counselling After Three Sessions over 4-6 Weeks
PHQ-9 Score | Treatment Response | Treatment Plan |
|---|
Drop of =5 points from baseline | Adequate | No treatment change needed Follow-up in 4 weeks. |
Drop of 2-4 points from baseline | Probably Inadequate | Possibly no treatment change needed.
Share PHQ-9 with psychological counsellor.
|
Drop of 1 point or no change or increase | Inadequate | If depression-specific psychological counselling ( CBT, PST, IPT*) discuss with therapist, consider adding antidepressant.
For patients satisfied in other type of psycholgical counselling, consider starting antidepressant.
For patients dissatisfied in other psychological counselling, review treatment options and preferences. |
* CBT - Cognitive-Behavioral Therapy; PST - Problem Solving Treatment; IPT- Interpersonal Therapy
HADS
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta PsychiatrScand 1983; 67: 361-370. <PubMed>
The HADS comprises statements which the patient rates based on their experience over the past week. The 14 statements are relevant to either generalised anxiety (seven statements) or 'depression' (again seven), the latter being largely (but not entirely) composed of reflections of the state of anhedonia (inability to enjoy oneself or take pleasure in everyday things enjoyed normally).
Even-numbered questions relate to depression and odd-numbered questions relate to anxiety. Each question has four possible responses. Responses are scored on a scale from 3 to 0. The maximum score is therefore 21 for depression and 21 for anxiety. A score of 11 or higher indicates the probable presence of the mood disorder (clinical caseness) with a score of 8 to 10 being just suggestive of the presence of the respective state. The two subscales, anxiety and depression, have been found to be independent measures. In its current form the HADS is now divided into four ranges: normal (0-7), mild (8-10), moderate (11-15) and severe (16-21). Movement between categories would constitute a clinically significant change in health status.
CORE: Clinical Outcome in Routine Evaluation
The 34 items of the measure covers four dimensions:
1. subjective well-being (4 items)
2. problems/symptoms (12 items)
3. life functioning (12 items)
4. risk/harm (6 items)
Rated 0=not at all to 4=most or all of the time.
Total scores for each domain are obtained by adding up the scores that correspond to the domain.
Mean scores are obtained by dividing the total score for each dimension by the number of items completed in that dimension.
Cut-off scores for clinical and non-clinical populations
| Non-clinical | Clinical |
|---|
| Dimension | Male | Female | Male | Female |
|---|
| All items | <1.19 | <1.29 | >1.19 | >1.29 |
|---|
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