Mood Disorder PHQ-9© PHQ-9-OV© SECTION D MOOD June 3, PM

Objectives Understand the importance of identifying signs and symptoms of mood distress so these can be treated Understand how to conduct the interview Understand the Total Severity Score Understand the importance of including this information on the care plan

D0100: Should Resident Mood Interview Be Conducted? Review: Is resident rarely or never understood? (B0700) Does resident want or need interpreter? (A1100) Is interpreter available? Code 0. No. Interview should not be attempted If resident rarely/never understood or needs or wants interpreter but one not available.  SKIP to D0500: Staff Assessment of Resident Mood Code 1. Yes. Interview should be conducted If resident at least sometimes understood, and if interpreter needed or wanted, one is available.

D0200: Resident Mood Interview PHQ-9© Patient Health Questionnaire - PHQ-9© 9-item validated interview Screens for symptoms of depression. Standardized severity score Two part assessment: Symptom presence Symptom frequency 14 day look-back period – may include preadmission

D0200: PHQ-9© Conduct interview preferably day before or day of ARD Quiet, private setting Be sure resident can see and hear you Provide paper form of interview if needed Explain reason for interview, “I am going to ask you some questions about your mood and feelings over the past 2 weeks. I will also ask you about some common problems that are known to go along with feeling down. These may seem personal, but everyone is asked to answer them. It will help us provide you with better care.”

D0200: PHQ-9© Tell resident and show cue cards “I am going to ask you how often you have been bothered by a particular problem over the last 2 weeks. I will give you the choices you see on this card.” 0-1 days—never or 1 day 2-6 days—several days 7-11 days—half or more of the days days—nearly every day.”

D0200: PHQ-9© Begin - “Over the past 2 weeks have you been bothered by any of the following problems?” For each questions (D0200A-I) Read as written Do not provide definitions, meaning based on resident’s interpretation Ask each question in sequence before going to next question: Presence in Column 1 Frequency in Column 2

D0200: PHQ-9© May respond to questions: Verbally Pointing to answers on cue card, or Writing out answers Symptom Frequency Select only one frequency response per item Choose higher frequency if: Difficulty choosing between two frequencies More than one phrase in item and chooses different frequencies

D0200 – PHQ-9© Coding Symptom – Presence & Frequency 14 Day Look Back

D0200. Resident Mood Interview Over the past two weeks have you been bothered by any of the following problems? A. Little interest or pleasure in doing things B. Feeling down, depressed, or hopeless C. Trouble falling or staying asleep, or sleeping too much D. Feeling tired or having little energy E. Poor appetite or overeating F. Feeling bad about yourself – or that you are a failure or have let yourself or your family down G. Trouble concentrating on things, such as reading the newspaper or watching television H. Moving or speaking so slowly that other people could notice. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual I. Thoughts that you would be better off dead or hurting yourself in some way.

D PHQ-9© Coding Coding Column 1 - Symptom Presence Code 0. No. Symptom not present Code 1. Yes. Symptom present Code 9. No Response. Resident unable or chose not to complete assessment, responded nonsensically, and/or facility not able to complete assessment Coding Column 2 - Symptom Frequency Code 0. Never or experienced symptom 1 day only Code 1. Experienced symptom on 2-6 days Code 2. Experienced symptom on 7-11 days Code 3. Experienced symptom on12-14 days Leave Blank – If Symptom Presence Code 9

D0300: PHQ-9© Total Severity Score Calculation: Add Numeric Scores D0200: Column 2 If any dashes or blanks - Appendix E -3 Software calculate If Frequency “blank” for 3 or more items Code Total Severity Score as 99 Complete D0500: Staff Assessment of Resident Mood

INTERVIEWING VULNERABLE ADULTS Here’s the link; m4_F7k m4_F7k

D0300: PHQ-9© Total Severity Score Extent of potential depression symptoms Standard score communicate to authorized staff Tracking of symptoms and changes in symptoms over time Score Interpretation at Coding Tips & Special Populations Major and Minor Depressive Syndrome : Minimal Depression : Moderate Depression : Mild Depression : Moderately Severe Depression : Severe Depression

D0350: Safety Notification Complete only if D0200.I. “Thoughts that you would be better off dead or of hurting yourself in some way” = 1. Yes Was responsible staff or provider informed that there is a potential for resident self harm? Code 1. No. Responsible staff or provider not informed potential for resident self-harm. Code 2. Yes. Responsible staff or provider informed.

D0500: Staff Assessment of Resident Mood – PHQ-9-OV© Assess mood of resident unable to complete interview Ensure information about mood not overlooked Coding presence of indicators does not automatically mean diagnosis of depression of other mood disorder

D0500: Staff Assessment PHQ-9-OV© 14 day look-back period Interview staff from all shifts who know resident best Same interview process, techniques, & higher symptom frequency choice used in resident interview Report symptom even if believe unrelated to depression If resident in facility <14 days, ask family, others & review transfer information

D0500. Staff Assessment of Resident Mood Over the past two weeks did the resident have any of the following problems or behaviors? A. Little interest or pleasure in doing things B. Feeling down, depressed, or hopeless C. Trouble falling or staying asleep, or sleeping too much D. Feeling tired or having little energy E. Poor appetite or overeating F. Indicating that s/he feels bad about self – or has let self or family down G. Trouble concentrating on things, such as reading the newspaper or watching television H. Moving or speaking so slowly that other people have noticed. Or the opposite – being so fidgety or restless that s/he has been moving around a lot more than usual I. Stresses that life isn’t worth living, wishes for death, or attempts to harm self J. Being short tempered, easily annoyed

D0500: Symptom Presence & Frequency Coding 14 Day Look Back

D0600: Total Severity Score PHQ-9© Calculation: Add Numeric Scores D0200. Symptom Frequency (Column 2) If any dashes or blanks - Appendix E Software calculate Interview complete if staff provide at least 8 out of 10 frequency responses

Total Severity Score Interpretation 1-4:minimal depression 5-9:mild depression 10-14:moderate depression 15-19:moderately severe depression 20-30:severe depression

D0650: Safety Notification Complete only if D0500.I. “States that Life isn’t Worth Living, Wishes for Death, or Attempts to Harm Self” = 1. Yes Was responsible staff or provider informed that there is a potential for resident self harm? Code 1. No. Responsible staff or provider not informed potential for resident self-harm. Code 2. Yes. Responsible staff or provider informed.

Care Plan Considerations Depression can be associated with psychological and physical distress, decreased participation, decreased function, and poorer outcomes Interventions need to be identified that could address symptoms

Questions? I’ll take the next few minutes to answer any questions you might have

Thank you!! Please feel free to contact me Shirley L. Boltz, RN RAI/Education Coordinator