The Utility of PHQ-9 as a Sensitive, Specific and Reliable Screening Tool for Depression and Suicidal Ideation in Patients with Chronic Wounds

Abstract Body: Chronic wounds can lead to depression (27%), anxiety (26%), and loss of function and mobility.1,2,3 Negative impact of emotional/mental stress on wound healing has been well documented.4,5,6 However, none of the previous studies used standardized rating scales for depression. Patient Health Questionnaire-9 (PHQ-9) is a commonly used self administered screening tool for depression. A score of greater than 9 is highly sensitive and specific (88%) for major depression.7 We conducted a retrospective study to estimate the incidence and characteristics of depression and suicidal ideation in subjects with chronic wounds. Seventy-nine patients were screened for depression at a hospital based wound care center using PHQ-9. Specific items on PHQ-9 were analyzed including suicidal ideation. Data was analyzed to correlate variables associated with depression. Items on routine clinical assessment were compared with the rating scales to detect any inconsistencies. Greater than 50 percent of the patients reported mild depression and of these nearly half qualified for diagnosis of major depression. The most significant areas of impairment were lack of interest or pleasure (mean score 2.5, with 63% of patients reporting a maximum score of 3), trouble falling or staying asleep (2.2, 68%) and feeling tired or having little energy (2.5, 63%). Suicidal ideation was reported by 3 patients on PHQ-9, which was missed by clinical staff on routine clinical assessment. None of the patients in the nondepressed group reported suicidal ideation. More than 70% of patients with clinically significant depression reported extreme functional impairment as a result of depression. The most common medical comorbidities were hypertension (68%), diabetes (50%), osteomyelitis (50%), and wound infection (41%). Conclusion: PHQ-9 is a convenient, and reliable tool to diagnose major depression and suicidal ideation in patients with chronic wounds with a significant impact on outcomes.