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Somatization and Symptoms Evaluation
Author Bios
Introduction
Defining Somatization
Detecting Symptoms
Dimensions of Symptoms
Measuring Symptoms
Psychiatric Comorbidity
Currently selected section: Interpreting Symptom Measures
Functional Syndromes and Symptoms
Etiology of Symptoms
Levels of Etiological Certainty
Strengthening Etiological Classification
Confounding Etiological Factors
Symptoms and Patient Expectations
Interpreting Patient Responses
Measuring Multiple Symptoms
Global Rating of Change
Measuring Somatization
Measuring Other Domains
Conclusions


Chapter 16: Somatization and Symptoms Evaluation: Interpreting Symptom Measures
         

The PHQ-9 is one measure for diagnosing depressive disorders (Kroenke et al., 2001). The PHQ-9 responses of the 30-year old female patient described previously are diagnostic for major depressive disorder. Her PHQ-15 responses are not inconsistent with a patient who might have somatization disorder as well, but typically the approach to somatization is that attention is first given to co-existing depressive or anxiety disorders since these can be important primary causes of somatization, and the latter can be substantially reduced with effective treatment of depression or anxiety. We have inadequate data in this case to make a diagnosis of either generalized anxiety disorder or borderline personality disorder.

The PHQ-9 is not the only brief measure for diagnosing depression. Its advantages are that it can serve as both:

  • a diagnostic instrument for establishing criteria-based diagnoses of DSM-IV disorders, and
  • a continuous measure for grading depression severity both at baseline and in response to treatment.

However, a number of other self-administered case-finding instruments for detecting depression exist, and no one instrument has proven superior to another (Williams et al., 2002). The PHQ also has an anxiety module for detecting panic and other anxiety disorders as well as modules for somatoform (the PHQ-15), alcohol, and eating disorders. The PHQ-15 and PHQ-9 (when used as separate measures) as well as the full PHQ instrument and scoring instructions are provided in Appendix 1.

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