Most participants felt that the information elicited by the PHQ-9 was instructive to the provider and helped to insure proper treatment. One participant explained, “It’s a way of [the provider] knowing how I feel… I don’t analyze it. It’s not the SAT,” referring to the Scholastic Aptitude Test taken by almost all U.S. high school students seeking admission to college.
Some participants also described using the PHQ 9 itself as a tool for self-management or reflection. One patient who disclosed that she was currently suffering a period of major depression, described her experience completing the PHQ 9 as,
“It was neat, but it was sad. I mean, it made me take a look at myself. And I didn’t really realize how depressed I was.”
A few participants reflected indifference towards the PHQ-9. These participants may have understood the medical utility of the questionnaire, but did not convey overt enthusiasm about it.
Two participants expressed skepticism about the PHQ-9’s ability to appropriately reflect their own symptoms of depression; however, this did not appear to impede their interest in the CCM as a whole. One patient described his skepticism towards some of the specific items in the PHQ-9:
“I’m always honest with the questions, you know. And then I started feeling like, I think my lack of interest on paper seems really bad. Because although I may have a lack of interest in doing something, to me I won’t say I’m depressed. I personally will say I’m just being lazy because I can be really lazy at times and don’t feel like doing nothin’. Like, I just literally want to lay down and watch TV and eat. Some people call that a form of depression. And it may be true for some people, but for me, I find comfort in it. I like it.”
Only one person voiced discontent about the PHQ-9. She reported numerous admissions to psychiatric hospitals, and believed that answering the questionnaire honestly would result in involuntary commitment to inpatient psychiatric care. When asked about the PHQ-9, she responded:
“If you don’t want help, you’re not going to tell the truth on it. And especially with the psych part, you’re not going to be truthful if you don’t want to go to the psych ward because they’re going to ship you right out to the psych ward. And that’s just a bunch of shit. I hate psych wards…That’s why a lot of people, and personally me, I don’t usually tell the truth on those forms.”
Underpinning the range of attitudes towards the PHQ 9 was the concept of trust. What seemed to distinguish this last patient’s case from others was the lack of trust in how the information gleaned from the PHQ 9 would be used, resulting in unwillingness to answer the questionnaire honestly. The other participants, by contrast, reported high levels of trust in their providers and in the larger medical system.