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Leadership
Published in Peter Davies, Lindsay Moran, Hussain Gandhi, Adrian Roebuck, Clare J Taylor, The New GP′s Handbook, 2022
So, you have largely accepted a follower role in the early part of your life. You will still be a follower for much of your professional life. For example, as a GP, I now do PHQ9 (Patient Health Questionnaire) scores to attempt to quantify the severity of the depression my patient is suffering from.3 This is an external imposition onto my style of medicine having everything to do with how I am paid (via the quality and outcomes framework (QOF)) and little to do with any medicine I know or personal wish for improvement. There is a more general argument as to whether or not condition-specific questionnaires improve the accuracy of clinical assessment or not, but I, like most GPs, have not used them very much in practice.4 So, in my use of the PHQ9 scores I am following the external and imposed leadership of the QOF, which believes that GPs will assess depression better if they use a scoring system rather than just their clinical nous. My motives for accepting the imposition are largely venial (to get paid) rather than clinical.
Depression
Published in Henry J. Woodford, Essential Geriatrics, 2022
Answering ‘yes' to either should lead to further assessment. The Patient Health Questionnaire (PHQ-9) is a nine-question screening test for depression used in primary care.15 The questions correspond to the DSM criteria for major depression and are rated for severity from zero to three (total score zero to 27). The Cornell scale can be used to evaluate depression in people with dementia (see later).
Lifestyle Medicine in the Care of Adolescent Girls
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Neeta B. Agarwal, Michelle Dalal
Stress has been described by Hans Selye as the body’s nonspecific response to any demand. Distress refers to stress caused by unpleasant stimuli, whereas eustress refers to stress caused by positive experiences. Teen years are a time of new experiences and many “firsts”, and as such, there is considerable distress and eustress along the way. External stressors abound – academic demands and career planning, social stressors including friendships, relationships, and peer pressure, possibly financial struggle and need for balancing employment with school, and injury or illness for some. Internal sources of stress – those that occur within us – originate from expectation and our mindset. For teens, internal stress includes identity formation, gender concerns, development of values and beliefs, role in family, and self-image. Spending one-on-one time during well visits provides opportunity for teens to share about these stressors. Screening tools include the Perceived Stress Scale (PSS) and the Pediatric ACEs (adverse childhood experiences) and Related Life Events Screener (PEARLS). Screening for mood with the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) Question Screener for anxiety, and the Ask Suicide-Screening Questions (ASQ) may also help identify mood concerns which contribute to stress. Screening for anxiety and depression is important at least once annually at well visits.
Posttraumatic stress disorder (PTSD) and mental health comorbidity in firefighters
Published in Journal of Workplace Behavioral Health, 2022
Nattinee Jitnarin, Sara A. Jahnke, Walker S. C. Poston, Christopher K. Haddock, Christopher M. Kaipust
The patient health questionnaire (PHQ) is a self-administered tool derived from the PRIME-MD (Primary Care Evaluation of Mental Disorders) designed to screen for psychiatric disorders according to the DSM-IV criteria (Spitzer, Kroenke, & Williams, 1999). In this study, the PHQ was used to assess seven disorders: four threshold disorders, corresponding to the specific DSM-IV diagnoses of major depressive disorder, panic disorder, other anxiety disorder, and bulimia nervosa; and three subthreshold disorders, for which the criteria include fewer symptoms than are required for specific DSM-IV diagnosis, including probable alcohol abuse or dependence, somatoform disorder, and binge eating disorder. All modules are widely used and have shown satisfactory internal consistency and exhibited reliability and validity (Kroenke, Spitzer, Williams, & Löwe, 2010; Spitzer et al., 1999, Spitzer, Williams, Kroenke, Hornyak, & McMurray, 2000).
Mechanisms and Methods to Understand Depressive Symptoms
Published in Issues in Mental Health Nursing, 2022
Sameena F. Sheikh-Wu, Kathryn S. Gerber, Melissa D. Pinto, Charles A. Downs
Depressive symptoms have been shown to predict and be a consequence of many physical health diseases. However, the causal relationship between depressive symptoms and many physical health diseases is unclear—that is, did the physical illness cause the depressive symptoms or did the depressive symptoms enhance the risk of developing the physical illness (e.g., persistent inflammation and associations with hypertension, diabetes, and pain). Emerging technologies and advances in science may provide the tools necessary for clinical nurses and nurse researchers to further our understanding of depressive symptoms and their causal linkage with physical illness. For example, the use of artificial intelligence (AI) can examine cases (depression) and non-cases (no depression) as defined by clinicians. From these data, AI can examine patterns within the data that are not readily apparent to humans and produce predictive algorithms. Because depressive symptoms are usually either undertreated or not treated at all, it would be important to identify risk as early as possible to prevent functional impairment, poor quality of life, and risk for acquiring other chronic diseases. To date, the gold standard for diagnosis of mood disorders is clinician assessment guided by the DSM-V. Clinical tools, such as the Patient Health Questionnaire (PHQ) are commonly used in clinical settings where psychiatric expertise is not available. Because there is no biomarker for depression, detection is dependent upon self-report of the patient through disclosure (e.g., chief complaint) or implementation of routine screening using such tools by providers as a standard of practice in primary care.
The relationship between occupational stress and gastrointestinal illness: A comprehensive study of public schoolteachers
Published in Journal of Workplace Behavioral Health, 2018
Krista Howard, Madeline Giblin, Rachel Medina
The Patient Health Questionnaire (PHQ) is a self-report measure used to identify the presence of psychological disorders and symptomatology. For the purposes of this study, the sections evaluating major depressive disorder, somatization disorder, anxiety disorder (nonspecific), and panic disorder were included (Kroenke, Spitzer, & Williams, 2001). To assess for major depression, participants responded to items such as, “Over the past two weeks, how often have you had trouble falling or staying asleep, or sleeping too much?” Using a 4-point Likert-type scale, participants would select one of the following: not at all, several days, more than half the days, and nearly every day. To assess for somatization disorder, participants were asked to respond by indicating whether he or she is not bothered at all, bothered a little, or bothered a lot to questions such as “During the last four weeks, how much have you been bothered by headaches?” To assess for an anxiety disorder, participants were asked to respond to items such as “Over the last four weeks, how often have you been bothered by feeling nervous, anxious, on edge, or worrying a lot about different things?” Responses included none at all, several days, and more than half the days. Lastly, to assess for panic disorder, participants were asked to respond yes or no to a series of items, such as “Think about your last anxiety attack. Were you short of breath?” The PHQ is considered a reliable tool in detecting the presence of Axis I disorders and has been validated against the Primary Care Evaluation of Mental Disorders (PRIME-MD) (Spitzer, Kroenke, & Williams, 1999).