General Hospital Psychiatry
Volume 32, Issue 4 , Pages 345-359 , July 2010

The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review

  • Kurt Kroenke, M.D.

      Affiliations

    • From Regenstrief Institute, Inc. and the Department of Medicine, Indiana University, Indianapolis, IN 46202, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 317 630 7447; fax: +1 317 630 6611.
    • ,
  • Robert L. Spitzer, M.D.

      Affiliations

    • Biometrics Research Department, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY 10032, USA
    • ,
  • Janet B.W. Williams, D.S.W.

      Affiliations

    • Biometrics Research Department, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY 10032, USA
    • ,
  • Bernd Löwe, M.D., Ph.D.

      Affiliations

    • Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik, Hamburg-Eilbek, Germany

Received 4 October 2009 ,Accepted 9 March 2010.

References 

  1. Spitzer RL, Williams JBW, Kroenke K, Linzer M, deGruy FV, Hahn SR, et al. Utility of new procedure for diagnosis mental-disorders in primary-care: the PRIME-MD 1000 Study. JAMA. 1994;272:1749–1756
  2. Spitzer RL, Williams JBW, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID). Arch Gen Psychiatry. 1992;49:624–629
  3. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381–389
  4. Wittchen HU. Reliability and validity studies of the WHO–Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res. 1994;28:57–84
  5. Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD — the PHQ primary care study. JAMA. 1999;282:1737–1744
  6. Spitzer RL, Williams JBW, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD Patient Health Questionnaire in assessment of 3000 obstetric-gynecologic patients: The PRIME-MD Patient Health Questionnaire Obstetrics Gynecology Study. Amer J Obstet Gynecol. 2000;183:759–769
  7. Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder — the GAD-7. Arch Intern Med. 2006;166:1092–1097
  8. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Lowe B. Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146:317–325
  9. Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258–266
  10. Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV, et al. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994;3:774–779
  11. Simon GE, Von Korff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999;341:1329–1335
  12. Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;12:34–43
  13. Kroenke K, Rosmalen JG. Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am. 2006;90:603–626
  14. Lowe B, Spitzer RL, Williams JBW, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008;30:191–199
  15. Helzer JE, Kraemer HC, Krueger RF. The feasibility and need for dimensional psychiatric diagnoses. Psychol Med. 2006;36:1671–1680
  16. Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22:1596–1602
  17. Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry. 2007;29:388–395
  18. van Ravesteijn H, Wittkampf K, Lucassen P, van de Lisdonk E, van den Hoogen H, van Weert H, et al. Detecting somatoform disorders in primary care with the PHQ-15. Ann Fam Med. 2009;7:232–238
  19. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9 — validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613
  20. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:509–515
  21. Williams JW, Pignone M, Ramirez G, Perez SC. Identifying depression in primary care: a literature synthesis of case-finding instruments. Gen Hosp Psychiatry. 2002;24:225–237
  22. Lowe B, Spitzer RL, Grafe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses. J Affect Disord. 2004;78:131–140
  23. Henkel V, Mergl R, Kohnen R, Allgaier AK, Moller HJ, Hegerl U. Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups. Gen Hosp Psychiatry. 2004;26:190–198
  24. Fann JR, Berry DL, Wolpin S, ustin-Seymour M, Bush N, Halpenny B, et al. Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer. Psychooncology. 2009;18:14–22
  25. Klapow J, Kroenke K, Horton T, Schmidt S, Spitzer R, Williams JBW. Psychological disorders and distress in older primary care patients: a comparison of older and younger samples. Psychosom Med. 2002;64:635–643
  26. Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care. 2004;42:1194–1201
  27. Huang FY, Chung H, Kroenke K, Spitzer RL. Racial and ethnic differences in the relationship between depression severity and functional status. Psychiatr Serv. 2006;57:498–503
  28. Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21:547–552
  29. Lowe B, Kroenke K, Herzog W, Grafe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. 2004;81:61–66
  30. Lowe B, Schenkel I, Carney-Doebbeling C, Gobel C. Responsiveness of the PHQ-9 to psychopharmacological depression treatment. Psychosomatics. 2006;47:62–67
  31. Wittkampf K, van Ravesteijn H, Bass K, van de Hoogen H, Schene A, Bindels P, et al. The accuracy of Patient Health Questionnaire-9 in detecting depression and measuring depression severity in high-risk groups in primary care. Gen Hosp Psychiatry. 2009;31:451–459
  32. Williams LS, Kroenke K, Bakas T, Plue LD, Brizendine E, Tu WZ, et al. Care management of poststroke depression — a randomized, controlled trial. Stroke. 2007;38:998–1003
  33. Mannel M, Kuhn U, Schmidt U, Ploch M, Murck H. St. John's wort extract LI160 for the treatment of depression with atypical features — a double-blind, randomized, and placebo-controlled trial. J Psychiatr Res 2010; doi: 10.1016/j.jpsychires.2010.01.010. [in press].
  34. Rogers WH, Adler DA, Bungay KM, Wilson IB. Depression screening instruments made good severity measures in a cross-sectional analysis. J Clin Epidemiol. 2005;58:370–377
  35. Cannon DS, Tiffany ST, Coon H, Scholand MB, McMahon WM, Leppert MF. The PHQ-9 as a brief assessment of lifetime major depression. Psychological Assessment. 2007;19:247–251
  36. Callahan CM, Boustani MA, Unverzagt FW, Austrom MG, Damush TM, Perkins AJ, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care — a randomized controlled trial. JAMA. 2006;295:2148–2157
  37. Williams LS, Jones WJ, Shen J, Robinson RL, Kroenke K. Outcomes of newly referred neurology outpatients with depression and pain. Neurology. 2004;63:674–677
  38. McManus D, Pipkin SS, Whooley MA. Screening for depression in patients with coronary heart disease (data from the heart and soul study). Am J Cardiology. 2005;96:1076–1081
  39. Holzapfel N, Zugck C, Muller-Tasch T, Lowe B, Wild B, Schellberg D, et al. Routine screening for depression and quality of life in outpatients with congestive heart failure. Psychosomatics. 2007;48:112–116
  40. Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry. 2007;29:417–424
  41. Whooley MA, de JP, Vittinghoff E, Otte C, Moos R, Carney RM, et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA. 2008;300:2379–2388
  42. Thombs BD, de JP, Coyne JC, Whooley MA, Frasure-Smith N, Mitchell AJ, et al. Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA. 2008;300:2161–2171
  43. Justice AC, McGinnis KA, Atkinson JH, Heaton RK, Young C, Sadek J, et al. Psychiatric and neurocognitive disorders among HIV-positive and negative veterans in care: Veterans Aging Cohort Five-Site Study. AIDS. 2004;18:S49–S59
  44. Monahan PO, Shacham E, Reece M, Kroenke K, Ong'or WO, Omollo O, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24:189–197
  45. Glasgow RE, Nutting PA, King DK, Nelson CC, Cutter G, Gaglio B, et al. A practical randomized trial to improve diabetes care. J Gen Intern Med. 2004;19:1167–1174
  46. Katon WJ, Simon G, Russo J, Von Korff M, Lin EHB, Ludman E, et al. Quality of depression care in a population-based sample of patients with diabetes and major depression. Med Care. 2004;42:1222–1229
  47. Drayer RA, Piraino B, Reynolds CF, Houck PR, Mazumdar S, Bernardini J, et al. Characteristics of depression in hemodialysis patients: symptoms, quality of life and mortality risk. Gen Hosp Psychiatry. 2006;28:306–312
  48. Dwight-Johnson M, Ell K, Lee PJ. Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer? Results from a randomized pilot study. Psychosomatics. 2005;46:224–232
  49. Kroenke K, Theobald D, Norton K, Sanders R, Schlundt S, McCalley S, et al. Indiana Cancer Pain and Depression (INCPAD) Trial: design of a telecare management intervention for cancer-related symptoms and baseline characteristics of enrolled participants. Gen Hosp Psychiatry. 2009;31:240–253
  50. Ell K, Xie B, Quon B, Quinn DI, Dwight-Johnson M, Lee PJ. Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol. 2008;26:4488–4496
  51. Lowe B, Willand L, Eich W, Zipfel S, Ho AD, Herzog W, et al. Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases. Psychosom Med. 2004;66:395–402
  52. Rosemann T, Backenstrass M, Joest K, Rosemann A, Szecsenyi J, Laux G. Predictors of depression in a sample of 1,021 primary care patients with osteoarthritis. Arthritis Care Res. 2007;57:415–422
  53. Persoons P, Vermeire S, Demyttenaere K, Fischler B, Vandenberghe J, Van Oudenhove L, et al. The impact of major depressive disorder on the short- and long-term outcome of Crohn's disease treatment with infliximab. Alimentary Pharmacol Therapeutics. 2005;22:101–110
  54. Picardi A, Amerio P, Baliva G, Barbieri C, Teofoli P, Bolli S, et al. Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Dermato-Venereologica. 2004;84:213–217
  55. Scholle SH, Haskett RF, Hanusa BH, Pincus HA, Kupfer DJ. Addressing depression in obstetrics/gynecology practice. Gen Hosp Psychiatry. 2003;25:83–90
  56. Leithner K, ssem-Hilger E, Fischer-Kern M, Loeffler-Stastka H, Sam C, Ponocny-Seliger E. Psychiatric morbidity in gynecological and otorhinolaryngological outpatients: a comparative study. Gen Hosp Psychiatry. 2009;31:233–239
  57. Lamoureux EL, Tee HW, Pesudovs K, Pallant JF, Keeffe JE, Rees G. Can clinicians use the PHQ-9 to assess depression in people with vision loss?. Optometry Vision Sci. 2009;86:139–145
  58. Maizels M, Smitherman TA, Penzien DB. A review of screening tools for psychiatric comorbidity in headache patients. Headache. 2006;46:S98–S109
  59. Persoons P, Luyckx K, Desloovere C, Vandenberghe J, Fischler B. Anxiety and mood disorders in otorhinolaryngology outpatients presenting with dizziness: validation of the self-administered PRIME-MD Patient Health Questionnaire and epidemiology. Gen Hosp Psychiatry. 2003;25:316–323
  60. Tietjen GE, Brandes JL, Digre KB, Baggaley S, Martin V, Recober A, et al. High prevalence of somatic symptoms and depression in women with disabling chronic headache. Neurology. 2007;68:134–140
  61. Turner JA, Dworkin SF. Screening for psychosocial risk factors in patients with chronic orofacial pain — recent advances. J Am Dent Assoc. 2004;135:1119–1125
  62. Gameroff MJ, Olfson M. Major depressive disorder, somatic pain, and health care costs in an urban primary care practice. J Clin Psychiatry. 2006;67:1232–1239
  63. Kroenke K, Bair M, Damush T, Hoke S, Nicholas G, Kempf C, et al. Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study design and practical implications of an intervention for comorbid pain and depression. Gen Hosp Psychiatry. 2007;29:506–517
  64. Dobscha SK, Corson K, Perrin NA, Hanson GC, Leibowitz RQ, Doak MN, et al. Collaborative care for chronic pain in primary care: a clustered randomized trial. JAMA. 2009;301:1242–1252
  65. Fann JR, Bombardier CH, Dikmer S, Esselman P, Warms CA, Pelzer E, et al. Validity of the patient health questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehab. 2005;20:501–511
  66. Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG. Symptoms of major depression in people with spinal cord injury: implications for screening. Arch Physical Med Rehab. 2004;85:1749–1756
  67. Lowe B, Grafe K, Kroenke K, Zipfel S, Quenter A, Wild B, et al. Predictors of psychiatric comorbidity in medical outpatients. Psychosom Med. 2003;65:764–770
  68. Turvey CL, Willyard D, Hickman DH, Klein DM, Kukoyi O. Telehealth screen for depression in a chronic illness care management program. Telemed J E-Health. 2007;13:51–56
  69. Nease DE, Nutting PA, Dickinson WP, Bonham AJ, Graham DG, Gallagher KM, et al. Inducing sustainable improvement in depression care in primary care practices. Jt Comm J Qual Patient Saf. 2008;34:247–255
  70. Duffy FF, Chung H, Trivedi M, Rae DS, Regier DA, Katzelnick DJ. Systematic use of patient-rated depression severity monitoring: Is it helpful and feasible in clinical psychiatry?. Psychiatr Serv. 2008;59:1148–1154
  71. Saliba D, Buchanan J. Development and validation of a revised nursing home assessment tool: MDS 3.0. Report for Centers for Medicare and Medicaid Services. HHS. 2009;
  72. Watson LC, Zimmerman S, Cohen LW, Dominik R. Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses. Am J Geriatric Psychiatry. 2009;17:556–564
  73. JOHNSON JG, Harris ES, Spitzer RL, Williams JBW. The Patient Health Questionnaire for Adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002;30:196–204
  74. Zuckerbrot RA, Jensen PS. Improving recognition of adolescent depression in primary care. Arch Pediatr Adolesc Med. 2006;160:694–704
  75. Zuckerbrot RA, Cheung AH, Jensen PS, Stein RE, Laraque D. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics. 2007;120:e1299–e1312
  76. Richardson L, McCauley E, Katon W. Collaborative care for adolescent depression: a pilot study. Gen Hosp Psychiatry. 2009;31:36–45
  77. Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Postpartum depression screening at well-child visits: validity of a 2-question screen and the PHQ-9. Ann Fam Med. 2009;7:63–70
  78. Weobong B, Akpalu B, Doku V, Owusu-Agyei S, Hurt L, Kirkwood B, et al. The comparative validity of screening scales for postnatal common mental disorder in Kintampo, Ghana. J Affect Disord. 2009;113:109–117
  79. Bennett IM, Coco A, Coyne JC, Mitchell AJ, Nicholson J, Johnson E, et al. Efficiency of a two-item pre-screen to reduce the burden of depression screening in pregnancy and postpartum: an IMPLICIT network study. J Am Board Fam Med. 2008;21:317–325
  80. Hanusa BH, Scholle SH, Haskett RF, Spadaro K, Wisner KL. Screening for depression in the postpartum period: A comparison of three instruments. J Womens Health. 2008;17:585–596
  81. Yonkers KA, Smith MV, Lin HQ, Howell HB, Shao L, Rosenheck RA. Depression screening of perinatal women: an evaluation of the Healthy Start Depression Initiative. Psychiatr Serv. 2009;60:322–328
  82. Hewitt CE, Gilbody SM, Brealey S, Paulden M, Palmer S, Mann R, et al. Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis. Health Technol Assess. 2009;13:1–230
  83. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12:439–445
  84. Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2 — Validity of a two-item depression screener. Med Care. 2003;41:1284–1292
  85. Corson K, Gerrity MS, Dobscha SK. Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. Am J Managed Care. 2004;10:839–845
  86. Lowe B, Kroenke K, Grafe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58:163–171
  87. Li CY, Friedman B, Conwell Y, Fiscella K. Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. J Am Geriatrics Soc. 2007;55:596–602
  88. Mitchell AJ, McGlinchey JB, Young D, Chelminski I, Zimmerman M. Accuracy of specific symptoms in the diagnosis of major depressive disorder in psychiatric out-patients: data from the MIDAS project. Psychol Med. 2009;39:1107–1116
  89. Rief W, Nanke A, Klaiberg A, Braehler E. Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J Affect Disord. 2004;82:271–276
  90. Lee PW, Schulberg HC, Raue PJ, Kroenke K. Concordance between the PHQ-9 and the HSCL-20 in depressed primary care patients. J Affect Disord. 2007;99:139–145
  91. Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114:163–173
  92. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Washington, DC: American Psychiatric Press Inc.; 1996;
  93. Unutzer J, Katon W, Callahan CM, Williams JW, Hunkeler E, Harpole L, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288:2836–2845
  94. Dietrich AJ, Oxman TE, Williams JW, Schulberg HC, Bruce ML, Lee PW, et al. Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial. BMJ. 2004;329:602–605
  95. Dobscha SK, Corson K, Hickam DH, Perrin NA, Kraemer DF, Gerrity MS. Depression decision support in primary care — a cluster randomized trial. Ann Intern Med. 2006;145:477–487
  96. Fortney JC, Pyne JM, Edlund MJ, Williams DK, Robinson DE, Mittal D, et al. A randomized trial of telemedicine-based collaborative care for depression. J Gen Intern Med. 2007;22:1086–1093
  97. Ell K, Quon B, Quinn DI, Dwight-Johnson M, Wells A, Lee PJ, et al. Improving treatment of depression among low-income patients with cancer: the design of the ADAPt-C study. Gen Hosp Psychiatry. 2007;29:223–231
  98. Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J, et al. Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet. 2008;372:40–48
  99. Richards DA, Lovell K, Gilbody S, Gask L, Torgerson D, Barkham M, et al. Collaborative care for depression in UK primary care: a randomized controlled trial. Psychol Med. 2008;38:279–287
  100. Kroenke K, Bair MJ, Damush TM, Wu J, Hoke S, Sutherland J, et al. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. 2009;301:2099–2110
  101. Strine TW, Mokdad AH, Balluz LS, Gonzalez O, Crider R, Berry JT, et al. Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv. 2008;59:1383–1390
  102. Pratt LA, Brody DJ. Depression in the United States household population, 2005-2006. NCHS Data Brief. 2008;7:
  103. Fleishman JA, Zuvekas SH. Global self-rated mental health: associations with other mental health measures and with role functioning. Med Care. 2007;45:602–609
  104. Taylor JK, Schoenbaurn M, Katon WJ, Pincus HA, Hogan DM, Unutzer J. Strategies for identifying and channeling patients for depression care management. Am J Managed Care. 2008;14:497–504
  105. Smith TC, Smith B, Jacobson IG, Corbeil TE, Ryan MAK. Reliability of standard health assessment instruments in a large, population-based cohort study. Ann Epidemiol. 2007;17:525–532
  106. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006;28:71–77
  107. Pirkis J, Pfaff J, Williamson M, Tyson O, Stocks N, Goldney R, et al. The community prevalence of depression in older Australians. J Affective Disorders. 2009;115:54–61
  108. Patten SB, Schopflocher D. Longitudinal epidemiology of major depression as assessed by the Brief Patient Health Questionnaire (PHQ-9). Comprehensive Psychiatry. 2009;50:26–33
  109. Desai MM, Rosenheck RA, Craig TJ. Case-finding for depression among medical outpatients in the Veterans Health Administration. Med Care. 2006;44:175–181
  110. Engel CC, Oxman T, Yamamoto C, Gould D, Barry S, Stewart P, et al. RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care. Mil Med. 2008;173:935–940
  111. Arnow BA, Hunkeler EM, Blasey CM, Lee J, Constantino MJ, Fireman B, et al. Comorbid depression, chronic pain, and disability in primary care. Psychosom Med. 2006;68:262–268
  112. Katzelnick DJ, Von KM, Chung H, Provost LP, Wagner EH. Applying depression-specific change concepts in a collaborative breakthrough series. Jt Comm J Qual Patient Saf. 2005;31:386–397
  113. Bremer RW, Scholle SH, Keyser D, Houtsinger JV, Pincus HA. Pay for performance in behavioral health. Psychiatr Serv. 2008;59:1419–1429
  114. Sederer LI, Silver L, McVeigh KH, Levy J. Integrating care for medical and mental illnesses. Prev Chronic Dis. 2006;3:A33
  115. Kendrick T, Dowrick C, McBride A, Howe A, Clarke P, Maisey S, et al. Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. BMJ. 2009;338
  116. Oxman TE, Dietrich AJ, Williams JW, Kroenke K. A three-component model for reengineering systems for the treatment of depression in primary care. Psychosomatics. 2002;43:441–450
  117. Kilbourne AM, Schulberg HC, Post EP, Rollman BL, Belnap BH, Pincus HA. Translating evidence-based depression management services to community-based primary care practices. Milbank Quarterly. 2004;82:631–659
  118. Lichtman JH, Bigger JT, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lesperance F, et al. Depression and coronary heart disease. recommendations for screening, referral, and treatment. Circulation. 2008;118:1765–1768
  119. Andrews G, Anderson TM, Slade T, Sunderland M. Classification of anxiety and depressive disorders: problems and solutions. Depress Anxiety. 2008;25:274–281
  120. Lee PW, Dietrich AJ, Oxman TE, Williams JW, Barry SL. Sustainable impact of a primary care depression intervention. J Am Board Fam Pract. 2007;20:427–433
  121. Lowe B, Grafe K, Zipfel S, Spitzer RL, Herrmann-Lingen C, Witte S, et al. Detecting panic disorder in medical and psychosomatic outpatients — comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians' diagnosis. J Psychosom Res. 2003;55:515–519
  122. Corapcioglu A, Ozer GU. Adaptation of revised Brief PHQ (Brief-PHQ-r) for diagnosis of depression, panic disorder and somatoform disorder in primary healthcare settings. Int J Psychiatry Clin Pract. 2004;8:11–18
  123. Means-Christensen AJ, Arnau RC, Tonidandel AM, Bramson R, Meagher MW. An efficient method of identifying major depression and panic disorder in primary care. J Behav Med. 2005;28:565–572
  124. Rollman BL, Belnap BH, Mazumdar S, Zhu F, Kroenke K, Schulberg HC, et al. Symptomatic severity of PRIME-MD diagnosed episodes of panic and generalized anxiety disorder in primary care. J Gen Intern Med. 2005;20:623–628
  125. Pilowsky DJ, Olfson M, Gameroff MJ, Wickramaratne P, Blanco C, Feder A, et al. Panic disorder and suicidal ideation in primary care. Depress Anxiety. 2006;23:11–16
  126. Kessler RC, Brandenburg N, Lane M, Roy-Byrne P, Stang PD, Stein DJ, et al. Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychol Med. 2005;35:1073–1082
  127. Lowe B, Decker O, Muller S, Brahler E, Schellberg D, Herzog W, et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care. 2008;46:266–274
  128. Issakidis C, Sanderson K, Corry J, Andrews G, Lapsley H. Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders. Psychol Med. 2004;34:19–35
  129. Roy-Byrne P, Veitengruber JP, Bystritsky A, Edlund MJ, Sullivan G, Craske MG, et al. Brief intervention for anxiety in primary care patients. J Am Board Fam Med. 2009;22:175–186
  130. Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med. 2008;70:890–897
  131. Sherbourne CD, Asch SM, Shugarman LR, Goebel JR, Lanto AB, Rubenstein LV, et al. Early identification of co-occurring pain, depression and anxiety. J Gen Intern Med. 2009;24:620–625
  132. Kroenke K, Sharpe M, Sykes R. Revising the classification of somatoform disorders: key questions and preliminary recommendations. Psychosomatics. 2007;48:277–285
  133. Dimsdale J, Creed F. The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV–a preliminary report. J Psychosom Res. 2009;66:473–476
  134. Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29:147–155
  135. Kroenke K. Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am. 2007;30:593–619
  136. Kroenke K, Spitzer RL, deGruy FV, Hahn SR, Linzer M, Williams JB, et al. Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry. 1997;54:352–358
  137. Kroenke K, Spitzer RL, deGruy FV, Swindle R. A symptom checklist to screen for somatoform disorders in primary care. Psychosomatics. 1998;39:263–272
  138. Interian A, Allen LA, Gara MA, Escobar JI, az-Martinez AM. Somatic complaints in primary care: Further examining the validity of the patient health questionnaire (PHQ-15). Psychosomatics. 2006;47:392–398
  139. Kroenke K, Messina N, Benattia I, Graepel J, Musgnung J. Venlafaxine extended release in the short-term treatment of depressed and anxious primary care patients with multisomatoform disorder. J Clin Psychiatry. 2006;67:72–80
  140. Gerber MR, Wittenberg E, Ganz ML, Williams CM, McCloskey LA. Intimate partner violence exposure and change in women's physical symptoms over time. J Gen Intern Med. 2008;23:64–69
  141. Escobar JI, Gara MA, az-Martinez AM, Interian A, Warman M, Allen LA, et al. Effectiveness of a time-limited cognitive behavior therapy type intervention among primary care patients with medically unexplained symptoms. Ann Fam Med. 2007;5:328–335
  142. Kroenke K, West SL, Swindle R, Gilsenan A, Eckert GJ, Dolor R, et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA. 2001;286:2947–2955
  143. Reuber M, Burness C, Howlett S, Brazier J, Grunewald R. Tailored psychotherapy for patients with functional neurological symptoms: a pilot study. J Psychosom Res. 2007;63:625–632
  144. Kroenke K. Physical symptom disorder: a simpler diagnostic category for somatization-spectrum conditions. J Psychosom Res. 2006;60:335–339
  145. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62:903–910
  146. Barsky AJ, Orav EJ, Bates DW. Distinctive patterns of medical care utilization in patients who somatize. Med Care. 2006;44:803–811
  147. Rost KM, Dickinson WP, Dickinson LM, Smith RC. Multisomatoform disorder: agreement between patient and physician report of criterion symptom explanation. CNS Spectr. 2006;11:383–388
  148. Hahn SR. Physical symptoms and physician-experienced difficulty in the physician-patient relationship. Ann Intern Med. 2001;134:897–904
  149. Jackson JL, Kroenke K. The effect of unmet expectations among adults presenting with physical symptoms. Ann Intern Med. 2001;134:889–897
  150. Smith RC, Lein C, Collins C, Lyles JS, Given B, Dwamena FC, et al. Treating patients with medically unexplained symptoms in primary care. J Gen Intern Med. 2003;18:478–489
  151. Jackson JL, O'Malley PG, Kroenke K. Antidepressants and cognitive-behavioral therapy for symptom syndromes. CNS Spectr. 2006;11:212–222
  152. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69:881–888
  153. Sha MC, Callahan CM, Counsell SR, Westmoreland GR, Stump TE, Kroenke K. Physical symptoms as a predictor of health care use and mortality among older adults. Am J Med. 2005;118:301–306
  154. Clarke DM, Piterman L, Byrne CJ, Austin DW. Somatic symptoms, hypochondriasis and psychological distress: a study of somatisation in Australian general practice. Med J Aust. 2008;189:560–564
  155. Mewes R, Rief W, Brahler E, Martin A, Glaesmer H. Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population. Gen Hosp Psychiatry. 2008;30:349–355
  156. Ryan MAK, Smith TC, Smith B, Amoroso P, Boyko EJ, Gray GC, et al. Millennium Cohort: enrollment begins a 21-year contribution to understanding the impact of military service. J Clin Epidemiol. 2007;60:181–191
  157. Kang HK, Li B, Mahan CM, Eisen SA, Engel CC. Health of US veterans of 1991 Gulf War: a follow-up survey in 10 years. J Occup Environ Med. 2009;51:401–410
  158. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358:453–463
  159. Harris AM, Orav EJ, Bates DW, Barsky AJ. Somatization increases disability independent of comorbidity. J Gen Intern Med. 2009;24:155–161
  160. Hanel G, Henningsen P, Herzog W, Sauer N, Schafert R, Szecsenyi J, et al. Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res. 2009;67:189–197
  161. Ormel J, Vonkorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA. 1994;272:1741–1748
  162. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JBW, deGruy FV, et al. Health-related quality-of-life in primary-care patients with mental disorders — Results from the PRIME-MD 1000 Study. JAMA. 1995;274:1511–1517
  163. Patel V, Araya R, Chowdhary N, King M, Kirkwood B, Nayak S, et al. Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychol Med. 2008;38:221–228
  164. Gilbody S, Richards D, Barkham M. Diagnosing depression in primary care using self-completed instruments: UK validation of PHQ-9 and CORE-OM. Br J Gen Pract. 2007;57:650–652
  165. Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B. Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behav Res Ther. 2009;47:910–920
  166. Mitchell AJ, Coyne JC. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br J Gen Pract. 2007;57:144–151
  167. Kroenke K, Spitzer RL, Williams JBW, Lowe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50:613–621
  168. Lowe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2009;
  169. Gilbody S, Sheldon T, House A. Screening and case-finding instruments for depression: a meta-analysis. CMAJ. 2008;178:997–1003
  170. Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006;166:2314–2321
  171. Williams JW, Gerrity M, Holsinger T, Dobscha S, Gaynes B, Dietrich A. Systematic review of multifaceted interventions to improve depression care. Gen Hosp Psychiatry. 2007;29:91–116
  172. U.S. Preventive Services Task Force . Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:784–792
  173. Gaynes BN, Rush AJ, Trivedi MH, Wisniewski SR, Balasubramani GK, McGrath PJ, et al. Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR*D. J Gen Intern Med. 2008;23:551–560
  174. Gilbody S, House A, Sheldon T. Psychiatrists in the UK do not use outcomes measures. National survey. Br J Psychiatry. 2002;180:101–103
  175. Zimmerman M, McGlinchey JB, Chelminski I. An inadequate community standard of care: lack of measurement of outcome when treating depression in clinical practice. Primary Psychiatry. 2008;15:67–75
  176. Trivedi MH. Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission. J Clin Psychiatry. 2009;70(Suppl 6):26–31

PII: S0163-8343(10)00056-3

doi: 10.1016/j.genhosppsych.2010.03.006

General Hospital Psychiatry
Volume 32, Issue 4 , Pages 345-359 , July 2010

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