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Screening for Depression

The VA/DOD Clinical Practice Guideline for the Management of Major Depressive Disorder recommends annual screening for depression, with more frequent screening for several high-risk populations, such as those with congestive heart failure, significant losses, chronic medical illness, or pregnant or postpartum women.

Patient Health Questionnaire

The Patient Health Questionnaire (PHQ) tools are designed to facilitate recognition and diagnosis of depression in primary care patients. The PHQ-2 is the recommended screening tool and patients who screen positive on the PHQ-2 should be provided further assessment of symptoms and risk. Providers should complete assessment for acute safety risks (e.g., harm to self or others, psychotic features, etc.) for all patients with suspected depression.

Depressive symptoms that require immediate attention, to include referral to emergency services or consultation with a mental health care provider:

  • Serious delusions (e.g., fixed false beliefs)
  • Visual or (typically) auditory hallucinations
  • Confusion (incoherence)
  • Catatonic behavior (e.g., motoric immobility or excessive agitation)
  • Extreme negativism or mutism
  • Peculiar movements
  • Inappropriate affect of a bizarre or odd quality
  • Severe symptoms 

Screening for Depression in Pregnancy and in the Postpartum Period

Women who are pregnant or postpartum are at elevated risk for depression and if untreated, depression can have adverse impacts on mother and child. The VA/DOD Clinical Practice Guideline for the Management of Major Depressive Disorder recommends screening for depression at first contact with a health care provider in the antenatal and postnatal periods, as well as at 4-6 weeks and then at 3-4 months in the postpartum period using the PHQ-2 or the Edinburgh Postnatal Depression Scale (EPDS). It should also be noted that the VA/DOD Clinical Practice Guideline for the Management of Pregnancy, released in 2018, can also assist health care providers in the evaluation, treatment, and management of pregnant patients, which includes recommendations for screening for depression.

Co-occurring Disorders with Depression

The diagnostic work-up for depression should include an evaluation for existing or emerging psychological and medical conditions that may exacerbate the depressive symptoms. Psychological conditions that may complicate treatment or put an individual at increased risk for adverse outcomes are bipolar disorder, posttraumatic stress disorder (PTSD), substance use disorder (SUD), suicidality or homicidality, and psychosis. Medical conditions may include cardiovascular diseases, chronic pain, degenerative disorders, immune disorders, metabolic endocrine conditions, neoplasms, or trauma.

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Patient Health Questionnaire - 2

Publication
4/7/2021

Patient Health Questionnaire (PHQ) tools are designed to facilitate recognition and diagnosis of depression in primary care patients. The PHQ-2 is the recommended screening tool and patients who screen positive on the PHQ-2 should be provided further assessment of symptoms and risk.

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Screening for Depression
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