Monitoring depression with the PHQ-9 in primary care: a qualitative study

Area of Science:

• Clinical Psychology
• Primary Care Medicine
• Health Services Research

Background:

• Primary care guidelines advocate for patient-reported outcome measures (PROMs) like the Patient Health Questionnaire (PHQ-9) to monitor adult depression.
• The PROMDEP trial evaluated the effectiveness and cost-effectiveness of the PHQ-9 for depression monitoring.
• Qualitative data were collected to understand patient and practitioner experiences with the PHQ-9.

Purpose of the Study:

• To explore patient and practitioner views on using the PHQ-9 within the PROMDEP trial for depression monitoring in primary care.
• To understand the facilitators and barriers to integrating the PHQ-9 into routine primary care consultations.

Main Methods:

• A nested qualitative study and process evaluation was conducted within the PROMDEP trial.
• Semi-structured telephone or video interviews were held with 29 patients and 15 practitioners.
• Thematic analysis was used to analyze the interview data.

Main Results:

• Both patients and practitioners recognized the value of the PHQ-9 for depression monitoring.
• Limitations were reported regarding the PHQ-9's impact on understanding depression, consultations, and integration into primary care workflows.
• Barriers to practitioner integration of the PHQ-9 may explain mixed findings in the PROMDEP trial.

Conclusions:

• Depression monitoring with PROMs must consider existing primary care processes and resources.
• Further research is essential to determine how to successfully integrate the PHQ-9 into clinical consultations.
• Optimizing PROM integration is key for effective depression management in primary care.