Utilization of PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)* 

This measure assesses the percentage of members 12 years of age and older with a diagnosis of major depression or dysthymia, who had an outpatient encounter with a PHQ-9 score present in their record in the same assessment period as the encounter. Major depressive disorder (MDD) is a leading cause of disability worldwide, affecting an estimated 120 million people. The lifelong prevalence is estimated to range from 10%–15%.51 In the United States, the 12‐month prevalence of MDD is 10.4%, with a lifetime prevalence of 20.6%.

Why It Matters?

Depression is also associated with other chronic medical conditions and increased morbidity and mortality. The mortality risk for suicide in depressed patients is more than 20-fold greater than in the general population.⁴ In terms of other chronic conditions, depression is associated with a 60% increased risk of type 2 diabetes, and has been identified as a risk factor for development of cardiovascular disease.¹ In adolescents, depression can also result in serious long-term morbidities such as generalized anxiety disorder and panic disorder, or lead to engagement in risky behaviors such as substance use.¹ Adolescent-onset depression increases the risk of attempted suicide by five-fold, compared with nondepressed adolescents. Most adolescents who commit suicide—the third leading cause of death among 15–24 year-olds—have a previous history of depression.²

Depression has large effects on both health care costs and lost productivity. Adolescents with depression have higher medical expenditures, including those related to general and mental health care, than adolescents without a diagnosis of depression.² In a survey study, Birnbaum et al. found that MDD severity is significantly associated with increased treatment usage and costs, unemployment, disability and reduced work performance.³

Numerous studies have found that patient outcomes improve when there is collaboration between a primary care doctor, case manager and a mental health specialist to screen for depression, monitor symptoms, provide treatment and refer to specialty care as needed.⁴ Standardized instruments are useful in identifying meaningful change in clinical outcomes over time. Guidelines recommend that providers establish and maintain regular follow‐up with patients diagnosed with depression and use a standardized tool to track symptoms.

*Adapted with financial support from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) under the CHIPRA Pediatric Quality Measures Program Centers of Excellence grant number U18HS020503, and with permission from the measure developer, Minnesota Community Measurement.

Historical Results – National Averages

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.