Depressive symptoms

Information sheet 3 - Patient Health Questionnaire – 9 items (PHQ-9)

Name of the instrument

Patient Health Questionnaire

Abbreviation

PHQ-9

Number of items

9

Terms of use

Public domain The source must be mentioned (Kroenke et al., 2001).

Language

English, French and several other languages

Data collection method

Self-report questionnaire or by interview, in hard copy, in person or by telephone.

Target population

Adults (possibly children starting in 4th grade)

Interpretation of the results and thresholds

  • The items are ranked on a scale of 0 to 3. The maximum score is 27.
  • The threshold for assessing moderate depression (10 or more) is used most frequently.
  • Thresholds:
    • Absence of depression: 0-4 points;
    • Mild depression: 5-9 points;
    • Moderate depression: 10-14 points;
    • Moderately severe depression: 15-19 points;
    • Severe depression: 20-27 points.

Is the questionnaire available in the toolkit?

Yes, see Questionnaire 2.

Other versions

  • The PHQ-2 includes the first two items of the PHQ-9. The PHQ-2 measures major depressive disorders but it does not measure the severity.
  • The PHQ-A for adolescents is similar to the PHQ-9 but uses vocabulary adapted to the target clientele (11 to 17 years of age). It has not been translated into French.
  • The PHQ-4 measures depression and anxiety based on the first two questions of the PHQ-9 and the first two questions of the GAD-7.
  • An additional question focuses on the level of psychosocial functioning.

References

  • Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med, 16(9), 606-613.
  • Kroenke, K. and Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509-515.
  • Pfizer (undated-a). Welcome to the Patient Health Questionnaire (PHQ) Screeners. PHQ and GAD-7 screeners. Consulted at https://www.phqscreeners.com/
  • Pfizer (undated-b). Instruction manual. Instructions for Patient Health Questionnaire (PHQ) and GAD-7 Measures. Consulted at https://www.ons.org/sites/default/files/PHQandGAD7_InstructionManual.pdf

Information sheet 4 - Center for Epidemiologic Studies – Depression Scale (CES-D)

Name of the instrument

Center for Epidemiologic Studies – Depression Scale

Abbreviation

CES-D

Number of items

20

Terms of use

Public domain. The source must be mentioned (Radloff, L. S. et al., 1977).

Language

English, French and more than 13 other languages

Data collection method

Self-report questionnaire or by interview, in hard copy, in person or by telephone.

Target population

Adolescents and adults

Interpretation of the results and thresholds

  • A four-point numbered scale. The items are ranked on a scale 0 to 3. The maximum score is 60. The scores are reversed for items 4, 8, 12 and 16.
  • The standard threshold is 16 points and indicates an individual at risk of depression. However, some studies state that the threshold is too low. Accordingly, the threshold can vary from 12 to 27 points, depending on the study. For example, Führer and Rouillon (1989), who validated the French translation of the instrument, recommend using a threshold of 17 for men and 23 for women.

Is the questionnaire available in the toolkit?

Yes, see Questionnaire 3.

Other versions

  • The CESD-R (CES-D-R; CES-DR) is the revised version of the CES-D. This instrument also contains 20 items, ranked on a five-level scale, as against a four-level scale in the CES-D, and certain items are different from the first version. While the revised version dates from 2004, most studies continue to use the first version (CES-D). There does not appear to be a validated version in French.
  • The CES-D10 is a short version of the CES-D. It fully repeats 10 of the 20 items in the CES-D and uses the same scale. A score of 10 or more on this instrument indicates the presence of symptoms of depression.
  • There are several other versions in which the number of items ranges from four to 16, and a version for young people (CES-D for children).

References

  • Furher, R. and Rouillon, F. (1989). La version française de l’échelle CES-D. Description et traduction de l’échelle d’auto-évaluation. Psychiatrie et Psychobiologie, 4, 163-166.
  • Radloff, L. S. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurements,1, 385-401.
  • The Center for Epidemiologic Studies Depression Scale Revised (CESD-R). (undated). About CESD-R. Consulted at http://cesd-r.com/about-cesdr/

Information sheet 5 - Mini International Neuropsychiatric Interview (MINI) – “Major depression episode” section

Name of the instrument

Mini International Neuropsychiatric Interview

Abbreviation

MINI (M.I.N.I)

Number of items

9

Terms of use

  • A licence must be obtained from Dr. David Sheehan, the lead author. The licence is free of charge if the project has a grant of less than $50 000 and if it is not used in a healthcare system, otherwise it costs $10 (see the entire array of criteria on the Harm Research Institute website: http://harmresearch.org/index.php/mini-international-neuropsychiatric-interview-mini/).
  • MAPI manages the translations. Fees are levied for the translated versions, in particular the French translation. The cost of distribution of the translation differs according to the use. It is roughly €750 for a commercial user, €100 for a funded university research project, e.g. government funding, and free of charge for non-funded research projects.

Language

English, French and more than 70 other languages

Data collection method

Was developed to be administered through a structured interview, with a trained interviewer.

Target population

Adults

Interpretation of the results and thresholds

If “yes” is the response to at least five questions, the person displays symptoms of a major depression episode.

Is the questionnaire available in the toolkit?

No

Other versions

The MINI is frequently updated to satisfy constantly-changing criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). At the time of dissemination of this toolkit, version 7.0.2 was the most recent version of the MINI and is based on the DSM-5. There is also a shorter MINI Screen version, suitable for screening. The MINI Kid targets children and adolescents. The MINI Plus is more comprehensive and covers 23 health problems.

References

  • eProvide et MAPI Research Trust. (2018). Mini-International Neuropsychiatric Interview (MINI). Consulted at https://eprovide.mapi-trust.org/instruments/mini-international-neuropsychiatric-interview
  • Sheehan, D., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1989). Mini-International Neuropsychiatric Interview (MINI): The development and validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. Journal of clinical psychiatry, 59(20), 22-33.
  • Sheehan, D., Lecrubier, Y., Sheehan, K. H., Amorim, J., Janavs, E., Weiller, a., … Dunbar, G. C.  (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(5), 232-241.

Last modified: 

January-12-21

How to cite: Canuel, M., Gosselin, P., Duhoux, A., Brunet, A., et Lesage, A. (2019). Post-Disaster Mental Health Impacts Surveillance Toolkit. Institut national de santé publique du Québec. Found at https://www.inspq.qc.ca/en/publications/2676(link is external).