Screening for Depression

Depression is one of the most common psychiatric disorders identified in various populations of hospitalized patients or patient's with chronic disease. Its presence among patients is noted to have an impact on a variety of outcomes measures. There has been a major push to get physicians in private practice and those in specialized medical setting to early identify those who might be suffering from depression and begin treatment.

There are several depression screening instruments that health care providers can use. Social workers in a hospital setting can use these screening questions as a part of their conversation and assessment of the individual. For example:

The PHQ-2 comprises the first two items of the PHQ-9, which is the full depression scale of the PHQ. The stem question is, “Over the last two weeks, how often have you been bothered by any of the following problems?” The two items are “little interest or pleasure in doing things” and “feeling, down, depressed, or hopeless” For each item, the response options are “not at all”, “several days”, “more than half the days”, and “nearly every day”, scored as 0, 1, 2, and 3, respectively. The score for the PHQ-2 can range from 0 to 6. A score of 3 or more on the two questions should lead you to suspect the individual is suffering from depression and could benefit from a more complete diagnostic evaluation.

When working with a medical population, it is important to distinguish between depression and demoralization. Demoralization is sometimes referred to as the "giving-up" complex. Some people who are demoralized can be depressed but many of them are not.

Recommending treatment for individuals with depression should be based upon clinical evidence about what is effective. Social workers need to know what is the recommended practice for treating depression as well as information about what works or doesn't work. Attached is just a small sampling of information that is out there about what interventions for depression.

Social work documentation should reflect your impression of the presence or absence of depression and education or recommendations made to patient.

Evidence Based Practice Information

Lowe, B., K. Kroenke, et al. (2005). "Detecting and monitoring depression with a two-item questionnaire (PHQ-2)." Journal of Psychosomatic Research 58(2): 163.

Mangelli, L., G. A. Fava, et al. (2005). "Assessing demoralization and depression in the setting of medical disease." J Clin Psychiatry 66(3): 391-4.