Transcript Depression Assessment(Abstract): G. Hirsch

Patient Health Questionnaire (PHQ) used to aid in
assessment of depressive symptoms
in Hepatitis C Viral (HCV) infection attending a
collaborative practice chronic liver disease clinic.
Hirsch G, Burgess C, Peltekian KM. Hepatology Services, Queen
Elizabeth II Health Sciences Centre, and Dalhousie University,
Halifax, NS, Canada
Background
Infection with the hepatitis C virus is a global problem with
the prevalence of around 3%and a tendency of becoming
chronic with 75% of the infected people.
The latest research indicates that chronic hepatitis C is
connected with a higher risk of the beginning of depression.
It also indicates that depression is more common with
patients who have a chronic HCV infection as compared with
other liver diseases.
Background
•For many living with HCV, the standard therapy of
peginterferon-alfa and ribavirin is either not an option or it
was unsuccessful.
•Whether an HCV-infected person has not attempted
standard therapy or is a non-responder, studies are finding
an increasing correlation with HCV infection and clinical
depression.
•The aim of this study was to determine the baseline
depression scores of a cohort newly referred HCV patients
seen in the clinic and also aid in evaluating the need for
continued psychiatry support.
Methods
•We have incorporated a depression assessment
using The Patient Health Questionnaire (PHQ-9)
for all our newly referred patients with the
diagnosis of Hepatitis C attending Hepatology
Services Chronic Liver Clinics
•As part of quality improvement project we
reviewed the information collected over 5 month
period
Tool
•The PHQ -9
– the nine item depression scale of the Patient Health
Questionnaire.
– a powerful tool for assisting primary care clinicians in
diagnosing depression as well as selecting and monitoring
treatment.
• There are two components of the PHQ-9:
– Assessing symptoms and functional impairment to
make a tentative depression
diagnosis, an
– Deriving a severity score to help select and monitor
treatment
– The PHQ-9 is based directly on the diagnostic criteria for
major depressive disorder in the Diagnostic and Statistical
Manual Fourth Edition (DSM-IV).
http://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9
/
What is the PHQ-9?
•PHQ -9 is a popular depression screener that has been
used in primary care populations
•PHQ-9 and the PHQ-2 a shortened version of the PHQ-9,
have been validated for use in older adults.
•The PHQ's performance has been studied in various
samples,
– including the general population both older adult home
health care clients
– community-based social services agency clients
receiving care management
– patients with various chronic conditions,
• including heart liver and renal diseases,
Simple and quick
•PHQ-9 is designed for self-completion by respondents and is in
clinics face-to-face and telephone interviews
•It is cognitively simple, taking only a few minutes to complete.
•Instructions to respondents are included in the questionnaire.
•The PHQ-9 Depression Screener is provided at in a variety of
languages www.phqscreener.com/
– including Arabic, Assamese, Chinese (Cantonese,
Mandarin), Czech, Dutch, Danish, English, Finnish, French,
French Canadian, German, Greek, Gujarati, Hindi, Hebrew,
Hungarian, Italian, Malay, Malayalam, Norwegian, Oriya,
Polish, Portuguese, Russian, Spanish, Swedish and Telugu
PHQ-9
•The PHQ-9 rates the frequency of symptoms which factors into the scoring
severity and there is a specific question that screen for the presences and
duration of suicidal ideation.
–
–
–
–
Scores of 5-9 are considered low
10-14 is mild depression
15-19 major depression
>20 is associated with severe major depression
RESULTS
The aim of this study was to determine the baseline depression scores of a
cohort newly referred HCV patients seen in the clinic and also aid in
evaluating the need for continued psychiatry support.
We collected PHQ-9 on 50 patients during a 5 month period
The mean age was 43years, of the participants 42 were male and 7 were
female.
The average score was 7.36;
63 % had scores between 0-9,
25% scored 10-14
12% greater than 15.
The individuals with high scores >15; 50 % were undergoing treatment for
their depression, 20 % of patients reported a history of anxiety/depression,
and 1% reported being on medication therapy.
Conclusion
•PHQ-9 is a brief and feasible measure of depressive symptoms in
patients with chronic hepatitis C .
•The tool easily identifies the patients who require further evaluation
and interventions of their symptoms.
•The tool is concrete and simple to incorporate into practice for new
HCV patients and an easy screening tool for those being
considered for antiviral treatment.
•Establishes a quick referral to mental health before and through
treatment process.
•Offered consistency in practice through the hepatology clinic.