Use of the Patient Health Questionnaire (PHQ-9) in Practice: Interactions between patients and physicians

Author:

Ford Joseph1ORCID,Thomas Felicity1,Byng Richard2,McCabe Rose3

Affiliation:

1. University of Exeter, Exeter, United Kingdom

2. University of Plymouth, Plymouth, United Kingdom

3. City, University of London, London, United Kingdom

Abstract

We analyze the use of nine-item Patient Health Questionnaire (PHQ-9), an instrument that is widely used in diagnosing and determining the severity of depression. Using conversation analysis, we show how the doctor deploys the PHQ-9 in response to the patient’s doubts about whether she is depressed. Rather than relaying the PHQ-9 verbatim, the doctor deviates from the wording so that the response options are selectively offered to upgrade the severity of the patient’s symptoms. This works in favor of a positive diagnosis and is used to justify a treatment recommendation that the patient previously resisted. This contrasted with the rest of the data set, where diagnosis was either not delivered (as patients are presenting with ongoing problems) or delivered without using the PHQ-9. When clinician-administered, the PHQ-9 can be influenced by how response items are presented. This can lead to either downgrading or upgrading the severity of depression.

Funder

Economic and Social Research Council

Publisher

SAGE Publications

Subject

Public Health, Environmental and Occupational Health

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