What is your assessment of the Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder (GAD) scores?

Assessment of PHQ-9 and GAD-7 Scores

The PHQ-9 and GAD-7 are validated screening tools for depression and anxiety respectively, with specific score thresholds indicating severity levels that should guide clinical decision-making and treatment planning.

Understanding PHQ-9 (Patient Health Questionnaire-9)

• PHQ-9 is a 9-item self-report scale assessing symptoms of major depressive disorder as defined by the DSM-IV, focusing on depressive symptoms and accompanying functional impairment 1
• Score interpretation for PHQ-9:
  • 1-7: Minimal symptoms of depression 2
  • 8-14: Moderate depressive symptomatology, requiring attention 2
  • 15-19: Moderate to severe depressive symptomatology, with symptoms interfering moderately to markedly with functioning 2
  • 20-27: Severe depressive symptomatology, requiring immediate intervention 2

Understanding GAD-7 (Generalized Anxiety Disorder-7)

• GAD-7 is a 7-item self-report scale assessing probable causes of generalized anxiety disorder 1
• Score interpretation for GAD-7:
  • ≥5: Mild anxiety 1
  • ≥10: Moderate anxiety 1, 3
  • ≥15: Severe anxiety 1, 3

Clinical Implications and Recommendations

• For PHQ-9 scores ≥8, conduct further diagnostic assessment to identify the nature and extent of depressive symptoms and determine presence or absence of a mood disorder 2, 1
• For PHQ-9 scores 8-14, consider low-intensity interventions such as guided self-help based on cognitive behavioral therapy or structured physical activity programs 2
• For PHQ-9 scores ≥15, refer to psychology and/or psychiatry for diagnosis and treatment 2
• For GAD-7 scores ≥10, consider pharmacologic treatment such as SSRIs, which have shown efficacy in treating generalized anxiety disorder 4, 5
• Special attention should be given to item 9 of PHQ-9 regarding self-harm thoughts; any positive response warrants immediate risk assessment 2

Diagnostic Accuracy Considerations

• The PHQ-9 has demonstrated good sensitivity (71%) and specificity (66%) at a cut-off of ≥10 for recognizing mood or anxiety disorders 6
• The GAD-7 has shown acceptable sensitivity (73%) and specificity (70%) at a cut-off of ≥9 for identifying anxiety disorders 6
• Both scales have demonstrated high internal reliability (Cronbach α values of .8 to .9) across multiple clinical trials 7

Common Pitfalls to Avoid

• Failing to complete the full assessment when initial screening items suggest depression or anxiety 2
• Omitting the self-harm item (item 9) from PHQ-9 assessment, which may artificially lower scores and miss critical risk information 2
• Not considering medical or substance-induced causes of significant depressive or anxiety symptoms, which should be determined and treated first 1
• Overlooking the common comorbidity between depression and anxiety - approximately 31% of patients with an anxiety disorder also have major depressive disorder 4

Integrated Assessment Approach

• For patients with elevated scores on both PHQ-9 and GAD-7, consider using the PHQ-ADS (PHQ Anxiety and Depression Scale), which combines both scales for a composite measure with cutpoints of 10,20, and 30 indicating mild, moderate, and severe levels of depression/anxiety respectively 7
• When multiple diagnoses are present, prioritize treatment for the condition causing the greatest functional impairment 4
• For any patient identified as at risk of harm to self and/or others, refer to appropriate services for emergency evaluation 1