Self-Rated Health (SRH) / Self-Rated Mental Health (SRMH)
Clinical Screening Questionnaires Training - page 5/10
Outcome Rating Scale (ORS)
Patient Health Questionnaire (PHQ-9)
Introduction
The Patient Health Questionnaire (PHQ)-9 is a nine-item, self-report questionnaire given to youth to screen for the presence and severity of depression and suicide risk in the past two weeks. It is extensively used in the areas of primary care and community mental health, and quantifies, determines, and monitors the severity of depressive symptoms and suicidal ideation, as well as treatment response, over time.
Why are we asking youth to complete this questionnaire?
The PHQ-9 has been found to be a reliable, valid, and sensitive measure of depression severity. At Youth Wellness Hubs Ontario (YWHO), in addition to using the PHQ-9 to grade the severity of youth depressive symptoms, its primary purpose is to critically alert service providers of a young person’s suicidal ideation (item 9), leading to the completion by the service provider of a more rigorous suicide severity measure (Columbia Suicide Severity Rating Scale (Screen Version) (C-SSRS(Screen Version))) with youth and, if relevant, a safety plan.
Responding to youth asking why they are being asked to complete this questionnaire:
It is a really positive step when young people come to the hub seeking support, care, and treatment for medical issues, or mental health and substance use concerns. We know that mental health and substance use issues can be related to thoughts of suicide, and that suicide is unfortunately a common occurrence among young people in Canada. So it is important that we ask each young person about it, as well as related feelings like sadness or hopelessness, which is what these questions are about. If you want, you would then have a safe place to talk about these feelings here.
Clinical questionnaire:
At the hub, when youth are provided the questionnaire on an iPad (or possibly in hard copy form), they receive the following instructions:
| Over the last two weeks, how often have you been bothered by any of the following problems? |
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1. Little interest or pleasure in doing thing:
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2. Feeling down, depressed, irritable, or hopeless:
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3. Trouble falling or staying asleep, or sleeping too much:
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4. Feeling tired or having little energy:
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5. Poor appetite or overeating:
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6. Feeling bad about yourself - or that you are a failure or have let yourself or family down:
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7. Trouble concentrating on things such as reading or watching television:
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8. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual:
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9. Thoughts that you would be better off dead or hurting yourself in some way:
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When do youth respond to these questions?
Young people are asked to complete this questionnaire at their first clinical visit, and subsequent clinical visits more than seven days later (either 8-29 days later, or 30 or more days, depending on when they return).
This questionnaire is not completed if youth visit the hub for service seven or fewer days after their last clinical visit.
What if youth don't understand a question?
If a young person requires assistance with an item due to developmental, cognitive, language, or other issues, try to provide these supports:
- Read all items aloud exactly as printed word for word, at an appropriate pace;
- If there is some misunderstanding, repeat the item;
- Determine which word is confusing and define the word, but try not to reword the question (it may alter the meaning of the question, as well as the response); and
- Do not suggest answers.
Scoring/Results
How can I go over results with youth?
Scoring is automatically calculated on the YWHO Data Collection platform, not by the service provider. (If the youth has not completed all questions, the platform will not automatically generate a score).
- Scores are attached to each of the youth’s nine responses where 0 = not at all, 1 = on several days, 2 = more than half of days, and 3 = nearly every day
- Scores are added up and can range from a total low of 0 to a maximum of 27
- Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress
- Scores can be viewed over time with the YWHO Data Collection platform progress tracker
| Score Range: | Interpretation/Recommended Intensity of Service (Low, Medium, High) |
|---|---|
| 0 - 4 | Depression severity of none/minimal (Low) |
| 5 - 9 | Depression severity of mild (Low) |
| 10 - 14 | Depression severity of moderate (Medium) |
| 15 - 19 | Depression severity of moderately severe (Medium/High) |
| 20 - 27 | Depression severity of severe (High) |
Item 9 - positive alert (see Alert below) | Thoughts of self-harm or being better off dead on several days, more than half of days, nearly every day in past two weeks → High |
Alert:
A positive response (“on several days,” “more than half of days,” or “nearly every day”) to question 9 (suicidal thoughts) triggers an immediate Data Collection Platform alert to a service provider at the site. The more comprehensive C-SSRS (Screen Version) is then completed by the service provider with youth in session.
- Please refer to your local site’s protocols regarding youth that are at risk for suicide as identified by the PHQ-9 and/or C-SSRS.
- Please remember that these screening instruments do not operate in isolation. Please take into account findings from other screening questionnaires, and use your clinical judgment and discussions with youth and their families to make the most appropriate decisions regarding assessment and interventions available at your specific YWHO site.
Video:
Self-Rated Health (SRH) / Self-Rated Mental Health (SRMH)
Outcome Rating Scale (ORS)
