Monitoring Depression Treatment Outcomes With the Patient Health Questionnaire-9
Abstract
BACKGROUND: Although effective treatment of depressed patients requires regular follow-up contacts and symptom monitoring, an efficient method for assessing treatment outcome is lacking. We investigated responsiveness to treatment, reproducibility, and minimal clinically important difference of the Patient Health Questionnaire-9 (PHQ-9), a standard instrument for diagnosing depression in primary care. METHODS: This study included 434 intervention subjects from the IMPACT study, a multisite treatment trial of late-life depression (63% female, mean age 71 years). Changes in PHQ-9 scores over the course of time were evaluated with respect to change scores of the SCL-20 depression scale as well as 2 independent structured diagnostic interviews for depression during a 6-month period. Test-retest reliability and minimal clinically important difference were assessed in 2 subgroups of patients who completed the PHQ-9 twice exactly 7 days apart. RESULTS: The PHQ-9 responsiveness as measured by effect size was significantly greater than the SCL-20 at 3 months (-1.3 versus -0.9) and equivalent at 6 months (-1.3 versus -1.2). With respect to structured diagnostic interviews, both the PHQ-9 and the SCL-20 change scores accurately discriminated patients with persistent major depression, partial remission, and full remission. Test-retest reliability of the PHQ-9 was excellent, and its minimal clinically important difference for individual change, estimated as 2 standard errors of measurement, was 5 points on the 0 to 27 point PHQ-9 scale. CONCLUSIONS: Well-validated as a diagnostic measure, the PHQ-9 has now proven to be a responsive and reliable measure of depression treatment outcomes. Its responsiveness to treatment coupled with its brevity makes the PHQ-9 an attractive tool for gauging response to treatment in individual patient care as well as in clinical research.
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The PHQ-9 has demonstrated good sensitivity, specificity, and convergent validity.
“The PHQ-9 has demonstrated good sensitivity, specificity, and convergent validity [49,50].”
The 4-point mean change in PHQ-9 scores was just short of the 5-point recommendation for clinical importance.
“Although the 4-point mean change in PHQ-9 scores was just short of the 5-point recommendation for clinical importance [40], this recommendation is based on a clinically unwell population.”
From A pilot evaluation of a smartphone application for workplace depression (2020) · cites this paper as [40]
For participants who were defined as having likely MDD at baseline, the mean change in PHQ-9 score from pre- to post-intervention was over 7 points, reaching the threshold of clinical importance for individual change.
“For participants who were defined as having likely MDD at baseline, the mean change in PHQ-9 score from pre- to post-intervention was over 7 points, reaching the threshold of clinical importance for individual change [40].”
From A pilot evaluation of a smartphone application for workplace depression (2020) · cites this paper as [40]
The 5-point recommendation for clinical importance is based on a clinically unwell population.
“Although the 4-point mean change in PHQ-9 scores was just short of the 5-point recommendation for clinical importance [40], this recommendation is based on a clinically unwell population.”
From A pilot evaluation of a smartphone application for workplace depression (2020) · cites this paper as [40]
The PHQ-9 is sensitive to change, has good sensitivity and specificity for detecting depressive disorders, and its psychometric properties are adequate.
“The PHQ-9 is sensitive to change, has good sensitivity and specificity for detecting depressive disorders, and its psychometric properties are adequate [62, 64, 65].”
The PHQ-9 is a valid measure in outpatient adult mental health settings, both as an initial screening tool and as a follow-up measure to monitor treatment progress.
“Several studies support its validity in outpatient adult mental health settings, both as an initial screening tool and as a follow-up measure to monitor treatment progress. 22-25”
From Dialectical behaviour therapy skills training: A feasibility study with active duty military. (2022) · cites this paper as [24]
The study observed clinically meaningful improvements in both anxiety and depression, with reductions in GAD-7 (-5.04) and PHQ-9 (-5.64) higher than the MCID for both conditions (3.8 and 5, respectively).
“As noted above, we observed clinically meaningful improvements in both anxiety and depression, with reductions in GAD-7 (− 5.04) and PHQ-9 (− 5.64) higher than the MCID for both conditions (3.8 and 5, respectively) [66, 67].”
From Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study (2022) · cites this paper as [67]
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- Authors
- L??we, B., Un??tzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K.
- Affiliations
- Regenstrief Institute (US)
- Venue
- Medical Care
- Published
- 2004-12
- Volume
- 42
- Issue
- 12
- Pages
- 1194-1201
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2049265876
- Cited by
- 1,354
- References
- 45
- Citations by year
- 2026: 89 · 2025: 103 · 2024: 92 · 2023: 101 · 2022: 114 · 2021: 117 · 2020: 84 · 2019: 56 · 2018: 71 · 2017: 54 · 2016: 65 · 2015: 55 · 2014: 60 · 2013: 48 · 2012: 57
- FWCI
- 27.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- PHQ-9, geriatric depression, treatment outcome monitoring, treatment response, test-retest reliability, minimal clinically important difference, remission, primary care depression, impact studies
- MeSH terms
- Aged, Major Depressive Disorder, Female, Humans, Interview, Psychological, Male, Primary Health Care, Psychiatric Status Rating Scales, Psychometrics, Quality of Life, Surveys and Questionnaires, Outcome Assessment, Health Care, Sickness Impact Profile, Dysthymic Disorder, Self Efficacy, Diagnostic and Statistical Manual of Mental Disorders
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