From the Guidelines
A PHQ-9 score of 4 indicates minimal depression symptoms, and according to the most recent guidelines, no referral to psychology and/or psychiatry for diagnosis and treatment is necessary at this stage. This score falls within the 0-4 range, which is considered the lowest severity category on the Patient Health Questionnaire-9 depression screening tool 1. At this level, no specific treatment for depression is typically required, but monitoring your mood is recommended. The PHQ-9 measures symptoms like low mood, sleep disturbances, fatigue, appetite changes, and difficulty concentrating over the past two weeks, with scores ranging from 0-27, as outlined in the management of anxiety and depression in adult survivors of cancer: asco guideline update published in the Journal of Clinical Oncology in 2023 1.
Some key points to consider include:
- The use of the word depression in the guideline refers to the PHQ-9 screening score and not to a clinical diagnosis 1.
- The guideline recommends regular screening at initial diagnosis/start of treatment, regular intervals during treatment, 3,6, and 12 months after treatment, diagnosis of recurrence or progression, when approaching death, and during times of personal transition or reappraisal such as family crisis 1.
- A score of 8 or higher is considered to indicate moderate to severe symptomatology, with symptoms interfering moderately to markedly with functioning, and would require a referral to psychology and/or psychiatry for diagnosis and treatment 1.
Given the current score of 4, it is essential to continue with healthy lifestyle habits such as regular exercise, adequate sleep, stress management techniques, and maintaining social connections, as these can help prevent worsening of symptoms. If you notice your symptoms increasing in frequency or severity, consider discussing this with your healthcare provider. Emotional well-being exists on a spectrum, and it's crucial to be attentive to changes in your mental health over time.
From the Research
PHQ-9 Score Interpretation
- A PHQ-9 score of 4 indicates mild depression symptoms 2, 3
- The Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument for diagnosing and determining the severity of depression 2
- The accuracy of the PHQ-9 has been evaluated in various studies, with a cut-off score of 10 commonly used to indicate moderate to severe depression 3
Treatment Options
- For adolescents with major depressive disorder, the combination of fluoxetine and cognitive-behavioral therapy (CBT) has been shown to be effective 4
- The combination of a selective serotonin reuptake inhibitor (SSRI) and CBT has been found to produce greater improvement than either treatment alone in youth with depression and anxiety 5
- Escitalopram has been found to be a effective SSRI in terms of response rate, remission rate, and withdrawal rate 6
Considerations
- The PHQ-9 can be influenced by how response items are presented, which can lead to either downgrading or upgrading the severity of depression 2
- Longitudinal studies are necessary to provide evidence of long-term screening effectiveness 3
- The added value of CBT with an SSRI occurs late in treatment, and interventions could be better tailored or adapted based on patient characteristics 5