Background/Purpose:  The PHQ-9 is a self-administered depression screening questionnaire. Patients with a PHQ-9 score of 0-4 have no depression, 5-9, mild; 10-14, moderate; 15-19, moderately severe; and 20-27, severe. A score ≥10 has a sensitivity of 88% and a specificity of 88% for major depression. Hypothesis: The PHQ-9 is a useful screening tool to identify depression in pediatric LN patients.

Methods:  A retrospective study cohort was identified using Slicer Dicer, an electronic medical record tool. Between 11/30/14 and 5/30/16, out of 1,602,679 in the database, there were 94 patients with LN. 60 subjects remained after exclusion criteria were applied. Data from a hospital survey of all Nephrology and Rheumatology patients, after introduction of the PHQ-2 score (5/1/16 to 1/31/17), was analyzed.

Results: 50 subjects were female, 10 were male, with a mean age of 17.4 ± 3.4 yrs. 39 subjects (65%) were Hispanic.

29 subjects (48% of all subjects) had a diagnosis of depression discoverable in EMR notes but only 14 subjects (23%) had a diagnosis of depression in their problem list. Only 2 of the 10 males had a diagnosis of depression.

Of the 45 of the 60 patients (75%) seen in the lupus multidisciplinary clinic, 27 of the 45 (60%) subjects had ≥1 PHQ-9 result. The 27 subjects (48%) who had discoverable PHQ-9 results, were not more likely to have a diagnosis of depression that those subjects who did not have PHQ-9 screening testing (p = 0.11). Only 2 of 15 (13%) subjects not followed in lupus clinic had ≥1 PHQ-9 value (p=0.0024). 2 the 7 subjects had PHQ-9 values recorded after referral to the Lupus Transition Clinic.

18 PHQ-9 values were ≥10 (14 moderate depression, 4 moderately severe depression, mean PHQ-9: 5.1 ± 5.1). 8 patients were not previously known to be depressed and 2 patients were suicidal. There was dramatic PHQ-9 score variability over time.

The PHQ-9 was made available to other sub-specialty groups once the study was presented to the hospital EMR group. Patient demand quickly outstripped the supply of psychiatric resources. The PHQ-9 was removed and PHQ-2 was substituted (Table 1) while a behavioral referral pathway was created.

Study patients using the PHQ-9 were more likely to report depression than general Rheumatology (p <0.01) or Nephrology (p <0.01) patients using the PHQ-2.

Conclusion: Slicer Dicer is a quick and effective means to identify study populations of interest in EPIC.

30% of subjects had PHQ-9 scores ≥10 and cases of new depression were detected. Thus, the PHQ-9 was a useful tool to identify LN patients with depression.

The use of the PHQ-9 questionnaire was used more often in a multidisciplinary LN setting with social workers and a physician “champion” for PHQ-9 use.

Hospitals utilizing the PHQ-9 need to be ready with increased psychological services for the newly identified patients who are depressed.

It is unclear if the PHQ-2 is equally useful in identifying depressed LN patients.

Key study limitations include: the failure to utilize the PHQ-9 for all LN patients and visits, some PHQ-9 were completed by nurses or social workers acting as a scribe for the patient, there was no evaluation of relationship between PHQ-9 values and SLEDAI-2K values and corticosteroid doses.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-health-questionnaire-9-utilization-for-the-detection-of-depression-in-adolescents-and-young-adults-with-lupus-nephritis/