Tana Fishman

Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population

PURPOSE Although screening for unipolar depression is controversial, it is potentially an efficient way to find undetected cases and improve diagnostic acumen. Using a reference standard, we aimed to validate the 2- and 9-question Patient Health Questionnaires (PHQ-2 and PHQ-9) in primary care settings. The PHQ-2 comprises the first 2 questions of the PHQ-9. METHODS Consecutive adult patients attending Auckland family practices completed the PHQ-9, after which they completed the Composite International Diagnostic Interview (CIDI) depression reference standard. Sensitivities and specificities for PHQ-2 and PHQ-9 were analyzed. RESULTS There were 2,642 patients who completed both the PHQ-9 and the CIDI. Sensitivity and specificity of the PHQ-2 for diagnosing major depression were 86% and 78%, respectively, with a score of 2 or higher and 61% and 92% with a score 3 or higher; for the PHQ-9, they were 74% and 91%, respectively, with a score of 10 or higher. For the PHQ-2 a score of 2 or higher detected more cases of depression than a score of 3 or higher. For the PHQ-9 a score of 10 or higher detected more cases of major depression than the PHQ determination of major depression originally described by Spitzer et al in 1999. CONCLUSIONS We report the largest validation study of the PHQ-2 and PHQ-9, compared with a reference standard interview, undertaken in an exclusively primary care population. The PHQ-2 score or 2 or higher had good sensitivity but poor specificity in detecting major depression. Using a PHQ-2 threshold score of 2 or higher rather than 3 or higher resulted in more depressed patients being correctly identified. A PHQ-9 score of 10 or higher appears to detect more depressed patients than the originally described PHQ-9 scoring for major depression.

Travelling companions: a story told by a patient and her doctor

The Patient and Clinician Engagement (PaCE) project1 involves collaborative dyads of North American patients and their family physicians/GPs working with university academics on participatory research projects to reduce disparities and improve community-based health outcomes.2 PaCE dyads meet annually at the North American Primary Care Research Group (NAPCRG) conference. ### Felicity: In my role as NAPCRG International Committee Chair, and Department Head of General Practice, University of Auckland, I initiated the first non-North American PaCE dyad. I approached my colleague Dr Tana Fishman, who in turn invited Rose Lamont, a patient of Pacific descent with whom she had a long-established doctor–patient relationship, to form their dyad. In November 2016 they travelled to the PaCE meeting at NAPCRG. This article describes their journey and its implications with respect to professional boundaries between doctors and their patients. ### Tana: Travelling to the airport to meet Rose felt very unusual. It was difficult explaining to colleagues and friends that I was travelling with my patient. I worried about maintaining professional boundaries and …

Students accompany acute hospital admissions from primary care

exercise. What was tried? A total of 105 Year 2 medical students participated in the PRT exercise in our affiliated children’s hospital during February– June 2010 as part of a required course entitled ‘Doctor and Humanities’. We randomly assigned the students to 15 groups of six to eight students and one faculty member facilitator per group. For the first 30 minutes of the PRT, participants individually explored hospital artwork in designated areas with the goal of identifying one work in response to the instruction: ‘Choose a piece of art in the hospital that you would share with a sick child and explain why.’ The group then reconvened to share a tour in which each participant acted as a tour guide for the respective chosen objects and briefly shared his or her responses. The faculty facilitator modelled empathic listening and managed time for the group. The request that participants evaluate the exercise achieved a response rate of 76%. The exercise received an overall rating of 4.3 on a 5-point Likert scale. Participants particularly cited its effectiveness in stimulating reflection on empathy (rating: 4.0) and community building among the group (rating: 4.3). In response to an open-ended question on learning outcomes, three major themes emerged. Firstly, participants greatly enjoyed this novel modality of sharing reflection and learning from peers. Secondly, participants reported experiencing enhanced empathy towards paediatric patients and their parents. Thirdly, participants emerged with greater awareness of the powerful impact of the hospital environment and its artwork on patients. One participant commented: ‘The exercise allowed us to slow down and to pay attention to sick children’s perspectives. I started to think about ways to reduce patients’ anxiety.’ What lessons were learned? Our study found that the PRT developed for museum settings translated well into hospital settings. Despite cultural differences in norms for sharing inner thoughts and feelings, the method worked well among medical students in Taiwan. The contribution of the facilitator as a role-model of an empathic listener during the tour is crucial to the success of this method. Given the increase in global interest in the contribution of artwork to the creation of therapeutic hospital environments, the use of hospital artwork in medical education has promising potential. REFERENCE