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Adolescent Risk Behaviors: Patient Health Questionnaire Case Study

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Updated: Apr 10th, 2021

Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population

A patient health questionnaire (PHQ) is a tool used in medical care settings for patient evaluation. PHQ-9 was specifically designed to determine depressive behaviors in patients. It consists of a list of statements that are measured by the degree of applicability to the patient. There are nine statements in total designed to identify symptoms of depression, such as thoughts about suicide, problems with concentration, change of appetite, and more. The replies are scored to determine the presence of depression and its level, including none, mild, moderate, moderately severe, and severe. However, there was a need to adjust the tool for younger patients, as there is evidence that depression symptoms may be experienced differently by patients of different ages (Burns, Dunn, Brady, Starr, & Blosser, 2016). PHQ-A is an adjusted tool, designed specifically for adolescent patients. There are not many changes in terms of the questions, but there are additional fields to evaluate the presence of symptoms in the past year, the occurrence of suicidal thoughts within the past month, and past suicide attempts.

Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability

PHQ-A has been widely discussed in scholarly medical research. The validity of PHQ-A rests primarily on the fact that the statements included on the questionnaire correspond to the typical symptoms of depression as reported by adolescents, such as tiredness, lack of motivation, apathy, insomnia, and irritability. The tool also evaluates the patient for suicidal thoughts and behavior, which may be provoked by depression. The reliability of the tool, on the other hand, has been supported by clinical trials. Most authors agree that the tool is useful in diagnosing depression in adolescents. For instance, Allgaier, Pietsch, Fruhe, Sigl-Glockner, and Schulte-Korne (2012) state that PHQ-A is as reliable as PHQ-9 when applied to adolescent patients, with a sensitivity of 73% and a specificity of 94% for Major Depression. Klonsky, May, and Glenn (2013) confirm that in past trials, “The PHQ-A has demonstrated excellent correspondence with structured interview measures of Axis I disorders” (p. 233).

Apply this evaluation tool to a patient situation and summarize your opinion of the results

At first look, the patient does exhibit depressive symptoms characteristic of moderate depression. The application of the PHQ-A questionnaire is needed to provide more evidence. The person does feel irritable most of the time, which scores her 2 on the first statement. She also takes little interest or pleasure in activities nearly every day, which accounts for 3 points on the second question. She has reported insomnia and weight game, which correlates with statements three and four, scoring a total of 4 points in these metrics. She also shows evidence of metrics five and seven, to a total of 6 points. The patient does not admit to suicidal thoughts, change to moving or speaking speed, and feeling bad about herself, which are metrics six, eight, and nine. Even if scores of 0 are applied to these statements, the overall score of the patient is 19, which is a borderline between moderately severe and severe depression.

Describe a plan of care for the patient, depending upon the results

Moderate, moderately severe, and severe cases of depression in adolescents are normally treated with a combination of antidepressants and psychotherapy (Cheung, Kozloff, & Sacks, 2013). Therefore, the first stage of the care plan would be to refer the patient to a psychotherapist, who can devise a treatment plan and confirm the need for the use of antidepressants. It is also crucial to introduce the patient to sources of help, such as telephone helplines, websites, and more, and to encourage the patient to seek help in case the symptoms get worse. Upon permission, the information about the patient’s symptoms has to be passed on to the parents to enable them to monitor her condition at home and to provide emotional support. Overall, the use of a suitable approach to treatment, as well as patient’s and parents’ cooperation with health professionals will help to alleviate the symptoms and treat depression.

References

Allgaier, A. K., Pietsch, K., Frühe, B., Sigl‐Glöckner, J., & Schulte‐Körne, G. (2012). Screening for depression in adolescents: Validity of the patient health questionnaire in pediatric care. Depression and anxiety, 29(10), 906-913.

Burns, C., Dunn, A., Brady, M., Starr, N. B., & Blosser, C. (2016). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier Saunders.

Cheung, A. H., Kozloff, N., & Sacks, D. (2013). Pediatric depression: An evidence-based update on treatment interventions. Current psychiatry reports, 15(8), 1-8.

Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between non-suicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of abnormal psychology, 122(1), 231-237.

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