University of Bristol, Academic Unit of Primary Care, 25-27 Belgrave Road, Clifton, Bristol BS8 2AAA.
Br J Gen Pract. 2010 Jun;60(575):e231-8. doi: 10.3399/bjgp10X502119.
In 2009, a new indicator (DEP 3) was introduced into the Quality and Outcomes Framework. GPs are now encouraged to assess response to antidepressant treatment 5-12 weeks after the initial assessment, to guide clinical decision making. The Patient Health Questionnaire (PHQ-9) is one of the validated instruments that GPs can use to assess the patient's clinical state.
To explore the extent to which changes in PHQ-9 score over time reflect patients' accounts of their experiences of depression during the same period; and to explore patients' experiences of using the PHQ-9 within primary care consultations.
Mixed methods.
Primary care.
Patients were recruited through six GP practices. The PHQ-9 and in-depth interviews were used at the same three time points over a 6-month period during a new or first episode of depression.
Patterns in the total PHQ-9 score broadly reflected patients' accounts of the severity of their depression over time. However, the PHQ-9 was inaccurate in its assessment of the presence and intensity of thoughts of self-harm, and missed symptoms that are meaningful to patients. At the diagnostic primary care consultation, patients viewed their score as a 'tangible' measure of their condition. Some patients requested the PHQ-9 subsequently as a way to measure their own treatment response and recovery process.
The potential therapeutic value of the PHQ-9 may be dependent upon the GP's willingness to openly discuss the results and what they may mean for the patient.
2009 年，质量和结果框架中引入了一个新指标（DEP 3）。现在鼓励全科医生在初始评估后 5-12 周评估抗抑郁治疗的反应，以指导临床决策。患者健康问卷（PHQ-9）是全科医生可用于评估患者临床状况的经过验证的工具之一。
探讨 PHQ-9 评分随时间的变化在多大程度上反映了患者在此期间对抑郁经历的描述；并探讨患者在初级保健咨询中使用 PHQ-9 的体验。
混合方法。
初级保健。
通过六家全科医生诊所招募患者。在新的或首次发作抑郁症期间的 6 个月内，在三个时间点同时使用 PHQ-9 和深入访谈。
总 PHQ-9 评分的模式大致反映了患者随时间推移对抑郁严重程度的描述。然而，PHQ-9 在评估自杀念头的存在和强度方面不准确，并且遗漏了对患者有意义的症状。在诊断性初级保健咨询中，患者将其分数视为自身病情的“有形”衡量标准。一些患者随后要求使用 PHQ-9 来衡量自己的治疗反应和康复过程。
PHQ-9 的潜在治疗价值可能取决于全科医生是否愿意公开讨论结果以及这些结果对患者意味着什么。
