1. Duckett, Kathy RN, BSN, PHN

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Q: Asking questions about depression is not easy. I keep being told that I should ask questions in a way my patient can understand, but I am also being told I have to ask the Patient Health Questionnaire-2 (PHQ-2) exactly as written on the Outcome and Assessment Information Set (OASIS-C). May I phrase the questions in a way that my patients will understand?


The PHQ-2 represents the first two questions in the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is a validated questionnaire that is used to assess the nine key symptoms of depression based on the Diagnostic and Statistical Manual of Mental Disorders (4th edition) diagnostic criteria for major depression. The PHQ-2 questions are the initial assessments of depression: a lack of interest in activities and a depressed mood. The PHQ-2 has been shown to be effective in screening for depression (Maurer, 2012). It is important not to paraphrase or alter the questions. Changing the questions that are asked might accidentally lead to false positives or false negatives, both of which could adversely affect the assessment of the patient. Recognizing the effect that limited literacy, or the potential that mild cognitive impairment may have on a patient's ability to understand and answer assessment questions is fundamental to an accurate assessment. Some experts acknowledge that you may need to change the way the questions are asked in order to promote understanding.


Sheeran et al. (2010) suggest that the PHQ-2 questions may be broken down to be more easily understood by patients with limited health literacy or for those who have mild cognitive impairment where the complexity of the questions might be beyond their ability to understand. They suggest the following:


The clinician can first ask about the presence of a symptom, then determine persistence (2 weeks or more), then determine pervasiveness (frequency of symptoms). For example:


"Have you had little interest or pleasure in doing things?" If yes ...


"How long have you been feeling this way?" Or, "Have you been feeling like this for at least two weeks?" If 2 weeks or more ...


"How often have you been feeling this way? Several days, more than half the days, or nearly every day?" (p. 97)


There are several ways to approach the PHQ-2 assessment. Sheeran et al. (2010) suggested being straightforward and telling the patient that you are going to ask them about how they are feeling right now. Another approach is to explain that sometimes people receiving home healthcare are going through difficult times, followed by stating that you want to ask them how they are feeling right now. Having empathy for the challenges patients face because of their illness or hospitalization, and the effect that may be having on how they feel, may lead to openness to discussing those feelings.


Clinicians are often required to ask difficult questions. Many times it is the clinician who is uncomfortable with the questions, not the patient. The clinician should first ask, "How comfortable am I with asking these questions? Is my discomfort getting in the way of me being able to effectively assess my patient for depression?"




Maurer D. M. (2012). Screening for depression. American Family Physician, 85(2), 139-144. Retrieved from[Context Link]


Sheeran T., Reilly C. F., Raue P. J., Weinberger M. I., Pomerantz J., Bruce M. L. (2010). The PHQ-2 on OASIS-C: A new resource for identifying geriatric depression among home health patients. Home Healthcare Nurse, 28(2), 92-102. doi:10.1097/NHH.0b013e3181cb560 [Context Link]