Depression screening and management

Clinical description

• Eligibility: screen all of the following patient groups routinely for depression:
• Returning to care after disengagement
• Known or suspected adherence problems
• High viral load

Patient Health Questionnaire (PHQ-2 and PHQ-9)

• Pre-screening (PHQ-2): ask all eligible patients aged 12 years + the first 2 questions from the PHQ.

o Score and add up the responses (range: 0–6)

o Patients with a PHQ-2 score of 3 or more need the full set of questions (PHQ-9)

• Full screening (PHQ-9): ask all patients with a PHQ-2 score of 3 or more all 9 questions

o Refer all patients with a score of 5 or more to a trained mental health counsellor.

Management of non-communicable diseases 57 Table 11: Patient Health Questionnaire for depression screening (PHQ-2 and PHQ-9)

Over the last 2 weeks, how often have you Several More than Nearly been bothered by any of the following? Not at all days half days every day 1 Little interest or pleasure in doing things 0 1 2 3 2 Feeling down, depressed, or hopeless 0 1 2 3 3 Trouble falling or staying asleep, or 0 1 2 3 sleeping too much 4 Feeling tired or having little energy 0 1 2 3 5 Poor appetite or overeating 0 1 2 3 6 Feeling bad about yourself — or that you 0 1 2 3 are a failure or have let yourself or your family down 7 Trouble concentrating on things, such as 0 1 2 3 reading the newspaper or watching television 8 Moving or speaking so slowly that other 0 1 2 3 people could have noticed? Or the opposite: being so fidgety or restless that you have been moving around a lot more than usual 9 Thoughts that you would be better off 0 1 2 3 dead or of hurting yourself in some way Total Score 0 + + + Scores Depression Severity Action 0-4 None-minimal Patient may not need depression treatment.

5-9 Mild Use clinical judgment about treatment, based on duration of 10 - 14 Moderate symptoms and functional impairment. Repeat PHQ-9 at next visit.

15 - 19 Moderately severe Treat using antidepressants or psychotherapy or a combination.

20 - 27 Severe Treat using antidepressants with or without psychotherapy.

Table 12: Patient Health Questionnaire for depression screening in Chichewa (PHQ-2 and PHQ-9)

M’masabata awiri apitawa ndi kangati mwakhala ndi chizindikiro chirichonse mwa Score zizindikiro izi? 1 M’masabata awiri apitawa, ndikangati mwakhala okhumudwa kapena kukhala opanda chiyembekezo (kutaya mtima) kapena nkhawa? 2 M’masabata awiri apitawa, ndikangati munavutika kukhala ndi chidwi chochepa kapena chilakolako pa zinthu (kusowa mphamvu, kukhala ndi nthumanzi, mtima wosweka)? Mwachitsanzo: kusafuna kukhala kapena kucheza ndi anzanu 3 M’masabata awiri apitawa, ndikangati mwakhala mukuvutika kupeza tulo (kulephera kugona kapena kukhala m’maso nthawi yogona) kapena kugona mopitilira/moposa nthawi zonse? 4 M’masabata awiri apitawa, ndikangati mwakhala mukumva kutopa, kukhala ndi ulesi, kufooka kapena kupelewera/kuchepa mphamvu? Mwachitsazo: kulephera kupanga ntchito za tsiku ndi tsiku 5 M’masabata awiri apitawa, ndikangati mwakhala mukusowa chilakolako cha chakudya kapena kudya kwambiri/mowonjeza? 6 M’masabata awiri apitawa, ndikangati munaziona ngati opanda pake (osazikhulupilira kapena wolephera kapena kuziona osafunikila/onyozeka) komanso kuti mwanyozetsa banja lanu? 7 M’masabata awiri apitawa, ndikangati munavutika kulephera kukhazikika pazochita, mwachitsanzo: kulephera kuwerenga kapena kulephera kukhazikika kumvera wailesi kapenanso kuwonera zowonera wonera, kucheza ndi anzanu, kulephera kuchita nawo zokambirana mumsonkhano? 8 M’masabata awiri apitawa, ndikangati mwakhala mukuyenda kapena kuyankhula pang’onopang’ono kwambiri mpakana anthu ena nkudabwa, kusakhazikika nkumangoyenda yenda moposera muyeso? 9 M’masabata awiri apitawa, ndikangati mwakhala ndi maganizo akuti kuli bwino kungofa kapena maganizo ofuna kuzivulaza nokha mwanjira ina iliyonse? Total Score Responses for each question Score Sindinavutikepo/ sindinakhalepo palibe ndi tsiku limodzi lomwe 0 Kusaposera sabata imodzi (Masiku 1-7) 1 Kuposera sabata imodzi (Masiku 8-12) 2 Pafupifupi tsiku lirilonse (Masiku 13-14) 3 Suitable antidepressants for patients on ART

• The preferred antidepressant for patients on DTG, ATV/r, LPV/r and DRV + r is citalopram.
• Check Table 29 on page 134 for interactions between ARVs and common antidepressants, and

recommended management.

Management of non-communicable diseases