Depression Screening at Your Checkup: What the Questions Mean and What Happens Next

World Mental Health Day is October 10, and early October is also when many communities hold depression screening days. It is a good time to know that a mental health check is part of routine primary care. The U.S. Preventive Services Task Force recommends screening all adults for depression, including during and after pregnancy and in older adults, and screening adults 64 and younger for anxiety.

Why your checkup asks about mood

Depression is common. In the most recent national survey, about 7.4 percent of U.S. adults, roughly 19.7 million people, had a major depressive episode in the past year. It does not always look like sadness; it can show up as poor sleep, low energy, aches or trouble concentrating. Asking everyone the same short questions catches what a busy visit might miss.

The questions, explained

Most practices use the Patient Health Questionnaire. The PHQ-2 is its first two questions: over the past two weeks, how often have you had little interest or pleasure in doing things, and how often have you felt down, depressed or hopeless? If either answer points to a problem, the full PHQ-9 follows. It has nine questions about sleep, energy, appetite, concentration and other symptoms, each scored from 0 to 3, for a total from 0 to 27.

What a score means

A screening score is not a diagnosis. It tells your provider whether to look more closely. In studies reviewed by the Task Force, the PHQ-9 at its standard cutoff of 10 identified about 85 percent of people with major depression. A higher score leads to a conversation about how long symptoms have lasted, what else might explain them, such as a thyroid problem, poor sleep or a medicine side effect, and what would help.

What happens next

If screening suggests depression or anxiety, the next step is a fuller evaluation. Options include counseling, medication, or both, and care can stay in the same practice that knows the rest of your health. The PHQ-9 also includes a question about thoughts of self-harm, so your provider can make sure you are safe.

Care from Hope Integrative Medicine

If you have been feeling down or anxious, bring it up at your next visit or schedule one now. We see adults in person at our West Ashley office and by telehealth across South Carolina, with primary care and mental health care in one practice. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.

Sources: USPSTF, Screening for Depression in Adults; USPSTF, Anxiety in Adults: Screening; SAMHSA, National Survey on Drug Use and Health; World Health Organization, World Mental Health Day; 988 Suicide & Crisis Lifeline.

Every patient is different. This article is general information, not medical advice, and may not apply to you. The right medication depends on your diagnoses, other health conditions and current medicines, so take medication only as directed by the provider managing your care. They are your best guide to the treatment that fits you.