PATIENT HEALTH QUESTIONNAIRE (PHQ-9)

PATIENT HEALTH QUESTIONNAIRE (PHQ-9) NAME: DATE: Over the last 2 weeks, how often have you been bothered by any of the following problems? (use "ⁿ" to indicate your answer) Not at all Several days More than half the days Nearly every day 1. Little interest or pleasure in doing things 2. Feeling down, depressed, or hopeless 3. Trouble falling or staying asleep, or sleeping too much 4. Feeling tired or having little energy 5. Poor appetite or overeating 6. Feeling bad about yourself or that you are a failure or have let yourself or your family down 7. Trouble concentrating on things, such as reading the newspaper or watching television 8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so figety or restless that you have been moving around a lot more than usual 9. Thoughts that you would be better off dead, or of hurting yourself add columns + + (Healthcare professional: For interpretation of TOTAL, please refer to accompanying scoring card). TOTAL: 10. If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult Copyright 1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD is a trademark of Pfizer Inc. A2663B 10-04-2005

PHQ-9 Patient Depression Questionnaire For initial diagnosis: 1. Patient completes PHQ-9 Quick Depression Assessment. 2. If there are at least 4 s in the shaded section (including Questions #1 and #2), consider a depressive disorder. Add score to determine severity. Consider Major Depressive Disorder - if there are at least 5 s in the shaded section (one of which corresponds to Question #1 or #2) Consider Other Depressive Disorder - if there are 2-4 s in the shaded section (one of which corresponds to Question #1 or #2) Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient. Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social, occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms. To monitor severity over time for newly diagnosed patients or patients in current treatment for depression: 1. Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at home and bring them in at their next appointment for scoring or they may complete the questionnaire during each scheduled appointment. 2. Add up s by column. For every : Several days = 1 More than half the days = 2 Nearly every day = 3 3. Add together column scores to get a TOTAL score. 4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score. 5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of response, as well as guiding treatment intervention. Scoring: add up all checked boxes on PHQ-9 For every Not at all = 0; Several days = 1; More than half the days = 2; Nearly every day = 3 Interpretation of Total Score Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression PHQ9 Copyright Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD is a trademark of Pfizer Inc. A2662B 10-04-2005

Edinburgh Postnatal Depression Scale (EPDS) for Postpartum Depression The Edinburgh Postnatal Depression Scale (EPDS) was developed in 1987 for screening postpartum women in outpatient, home visiting settings, or at the 6-8 week postpartum examination. It has been utilized among numerous populations, including US women and Spanish-speaking women in other countries. The scale has since been validated, and evidence from a number of research studies has confirmed the tool to be both reliable and sensitive in detecting depression. The EPDS consists of 10 questions and can usually be completed in less than 5 minutes. Validation studies have utilized various threshold scores in determining which women were positive and in need of referral. Cut-off scores range from 9 to 13 points. A woman scoring 9 or more points or indicating any suicidal ideation that is, she scores 1 or higher on question #10 should be referred immediately for follow-up. The EPDS score should not override clinical judgment. A careful clinical assessment should be carried out to confirm the diagnosis. The scale indicates how the mother has felt during the previous week. In doubtful cases it may be useful to repeat the tool after 2 weeks. The scale will not detect mothers with anxiety neuroses, phobias, or personality disorders. SCORING Questions 1, 2, and 4 (without an *) are scored 0, 1, 2, or 3, with the top box scored as a 0 and the bottom box scored as a 3. Questions 3 and 5-10 (marked with an *) are reverse-scored, with the top box scored as a 3 and the bottom box scored as 0. Maximum score: 30 Possible depression: 10 or higher Always look at Question #10, which indicates suicidal thoughts INSTRUCTIONS 1. The mother is asked to underline 1 of 4 possible responses that comes the closest to how she has been feeling the previous 7 days. 2. All 10 items must be completed. 3. Care should be taken to avoid the possibility of the mother discussing her answers with others. 4. The mother should complete the scale herself, unless she has limited English or has difficulty with reading.

Edinburgh Postnatal Depression Scale (EPDS) Form* Name Your Date of Birth Baby s Date of Birth: Address: Phone: SAMPLE QUESTION: As you are pregnant or have recently had a baby, we would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today. Here is an example, already completed. I have felt happy: Yes, all the time No, not very often This would mean: I have felt happy most of the time during the past week. Please complete the other questions in the same way. In the past 7 days: 1. I have been able to laugh and see the funny side of things As much as I always could Not quite so much now Definitely not so much now Not at all 2. I have looked forward with enjoyment to things As much as I ever did Rather less than I used to Definitely less than I used to Hardly at all *3. I have blamed myself unnecessarily when things went wrong Yes, some of the time No, never 4. I have been anxious or worried for no good reason Hardly ever Yes, very often *5. I have felt scared or panicky for no very good reason Yes, quite a lot No, not much *6. Things have been getting on top of me I haven t been able to cope at all I haven t been coping as well as usual No, most of the time I have coped quite well No, I have been coping as well as ever *7. I have been so unhappy that I have had difficulty sleeping *8. I have felt sad or miserable *9. I have been so unhappy that I have been crying Only occasionally No, never *10. The thought of harming myself has occurred to me Sometimes Hardly ever Administered/Reviewed by Date *Source: Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Sclae. Br J Psychiatry. 1987;150:782-786. Users may reproduce the scale without further permission providing they respect copyright by quoting the names of the authors, the title, and the source of the paper in all reproduced copies.

Care Pathway for Postpartum Depression Using the Edinburgh Postnatal Depression Scale (EPDS) Client is pregnant, or has been pregnant within the past 12 months YES Do you, the client, or the partner suspect that the mother has symptoms of depression? NO Using clinical assessment and judgment, ask the mother questions to determine: - Affect - Coping - Social Support - Maternal-Child Interaction - Depression Symptoms Ask mother to complete EPDS: - In privacy - Check if language support needed - Make lead-in statement and offer instructions for completing YES Is there a risk of suicide, harm to infant or others, or a positive score on EPDS self harm item #10 NO Result Positive for EPDS Question #10: Immediately assess further - Follow agency/practice guidelines for selfharm or suicidal ideation - Document evidence in records - Do not leave client by herself or alone with baby - Engage support system - Decide treatment plan with client Treatment Plan? EPDS Score: 4 or Less Your client does not seem to suffer from PPD. You may ask you client to take this test again at the next visit 4 or Less 10 or More EPDS Score? 5 to 9 EPDS Score: 5 to 9 Women with this score are at an increased risk for major depression. Provide information about signs of depression, options for treatment and methods to reduce risk. Follow-up at next visit. Refer for Counseling Negative Evaluate results of treatment in 4-6 weeks Antidepressant therapy Positive Result Negative: Routine Care EPDS Score: 10 or More It is very likely that your client is depressed. She needs further evaluation or referral for further evaluation. Use clinical judgment and further diagnostic evaluation in combination with EPDS to plan care. You should discuss the symptoms, diagnosis, and treatment plan with you client and help facilitate timely care. Outcome Negative: Refer for mental health services. Outcome Positive: Document evidence in medical record. Continue antidepressant 9-12 months after symptoms remitted. Evaluate every 3 months as needed. Disclaimer: Information provided is intended to increase knowledge on perinatal mood disorders. This is intended as a tool only, and should be used in conjunction with the professional s own assessment and clinical judgment. This information is not intended as a replacement for diagnosis or treatment by a qualified healthcare provider. Based upon PPD Care Pathway Developed by MedEdPPD.org