PHQ-2 and PHQ-9 in Home Health
The PHQ-2 and PHQ-9 (Patient Health Questionnaire) are standardized depression screening instruments embedded in OASIS Section D as the Patient Mood Interview (D0150). The two-question PHQ-2 acts as a gateway: patients who screen positive on the first two questions continue through the full nine-question PHQ-9, producing a severity score (D0160) that informs care planning and referrals.
How the mood interview works
The interview begins with the two PHQ-2 questions: over the last two weeks, how often the patient has been bothered by little interest or pleasure in doing things, and by feeling down, depressed, or hopeless. Each records symptom presence and frequency. If the gateway responses indicate sufficient symptom frequency, the clinician continues through the remaining seven questions covering sleep, energy, appetite, self-worth, concentration, psychomotor changes, and thoughts of self-harm. D0160 totals the severity score, with higher scores indicating more severe depressive symptoms on the standard PHQ scale of 0 to 27. The items came into OASIS with the OASIS-E redesign, aligning home health with mood screening in other post-acute settings.
Why depression screening matters in this population
Depression is common, underdiagnosed, and expensive in home health patients. It suppresses participation in therapy, medication adherence, nutrition, and self-care, which drags on the functional improvement your OASIS outcomes measure. It also travels with hospitalization risk. Because clinicians see patients in their homes, they are positioned to catch what an office visit misses: the empty refrigerator, the unopened pill organizer, the patient who has stopped getting dressed. A structured screen converts those observations into a documented severity signal that justifies intervention rather than a vague concern in a narrative note.
Administering the interview well
The PHQ items are a scripted patient interview, not a clinician impression. Ask the questions as written, in a private moment, using the patient's own responses; do not paraphrase into yes/no or fill in answers from observation. When the patient cannot communicate or reliably respond, follow the instrument's conventions for noting that rather than guessing. Any endorsement of self-harm thoughts requires an immediate safety response and practitioner notification, not just a recorded score. Scores should flow into action: practitioner communication, medical social worker referral, medication review, and follow-up when scores suggest clinically significant symptoms.
Common pitfalls
The failure patterns are familiar from other structured interviews:
- Rewording the questions until the instrument is no longer standardized
- Recording clinician judgment instead of the patient's actual responses
- Stopping at the PHQ-2 when gateway responses required continuing
- Documenting a high score with no corresponding care plan response
- Treating the self-harm item as routine data rather than a safety trigger
Frequently asked questions
What is the difference between the PHQ-2 and PHQ-9?
The PHQ-2 is the first two questions, screening for depressed mood and anhedonia. The PHQ-9 adds seven more symptom questions and yields a severity score from 0 to 27. In OASIS D0150, the PHQ-2 functions as a gateway that determines whether the full interview continues.
Does a high PHQ score change the plan of care?
It should. Clinically significant scores warrant practitioner notification and consideration of interventions such as medical social worker referral, medication evaluation, and closer monitoring. A documented high score with no care plan response is a quality and survey liability.
What if the patient endorses thoughts of self-harm?
That item is a safety trigger, not just a data point. The clinician follows the agency's crisis protocol immediately, which typically includes assessing immediacy of risk, notifying the practitioner, engaging emergency resources when warranted, and documenting the response.