Wednesday, 6 June 2007

Questionnaires

I have already mentioned the depression questionnaire which we are now obliged to administer to patients when we make a diagnosis of depression (on pain of losing some of our annual QOF payment). I have mixed feelings about this. On the one hand I dislike being forced to do things inflexibly, it is one more thing to remember, and the questionnaire may be difficult to administer if the patient has a poor command of English or lower than average intelligence. On the other hand it can help to corroborate my assessment of the depth of depression at the initial consultation when I am considering treatment options, and it is helpful later when I want to assess progress and can look back at a semi-quantitative score. I had noticed that people fill in the form in different ways, but had not really thought about what this might reveal. Typically Martha (my remarkable colleague) has thought more deeply about the subject. She writes:
I have been watching the way people fill in their depression questionnaires. Today I saw X who had to check each answer with me before she would mark a box, which I think was about her dependency. Other people known to be at the histrionic end sometimes fill in all their answers in the right hand column when in fact they don't appear that different from their usual selves. Then their answers may be more about their very overwhelming emotional world - or else about their need to shout, to get heard maybe. But sometimes, especially with men, I get a surprise and it looks as if they are genuinely more affected by depression then they seem. That is quite a useful consequence of the questionnaire.
I shall have to keep my eyes open a bit more.

6 comments:

Gavin Jamie - QOF database said...

That has been very much my perception as well. The answers, certainly from those patients who have a conscious view of their mental state, tend to reflect their perception of the severity of their illness.
We use the PHQ9 questionnaire and it does seem peculiar that you get the same points for sleeping poorly every night as spending every waking hour planning suicide.
Readers can try for themselves here

Ms-Ellisa said...

This is the first time I hear about a questionnaire on depression. How are you sure that the patient won't be lying in order to appear more or less depressed, and if you don't rely on the questionnaire to assess their health, then why have it anyway?
I suppose it must help somehow, but it seems to me very impersonal and I've always thought of depression as an illness which someone should feel comfortable with a doctor to admit...

Dr Andrew Brown said...

Gavin: Now you musn't go challenging the value of the questionnaire, it's been Validated, you know! :-)

Ms-Ellisa: You're right that you can't be sure that the patient isn't lying, but this applies all the time, not just when they are filling in questionnaires! That's why the final score is only one element in your assessment. Like fire, it's a good servant but a bad master.

Antigonos said...

Gee whiz, I'm suffering from "moderate depression" according to the questionaire! And this is the way I feel after taking my anti-depressant!

Of course, mightn't at least some of my symptoms be related to the ruptured intravertebral disc and the type 2 diabetes I have, and the fact that I'm 61 and will have to subsist--if I can ever retire--on a government old age allowance as my pension is gone (pension fund plundered by the employer before declaring bankruptcy).

Nowhere is it noted that I manage to hold down a job, run a household of 5 people, do the shopping, etc. Seems an odd way to diagnose depression to me!

Anonymous said...

Much against my better judgment I have taken the Cosmo Quiz 'Just how depressed are you?' and my score is officially somewhere between Eeyor and Puddleglum, but not quite as bad as Gollum at the point where he bit off Frodo's finger.

That is because I hold that anybody who is not depressed simply has not understood the situation.

To cheer myself up I am going to the cinema to see the new heart-warming documentary 'Taking Liberties'. This is the life enhancing tale of how freedom in civil society has been shredded over the last decade, although in truth the rot set in a lot earlier.

In my opinion, it is the grinning ninnies who have got the real problem. People like Yvette Cooper who means to inflict hours of pointless repetion and extra expense into housebuying, and honestly seems to think this is a good idea. That makes me depressed.

Hey, cheery thought. If HIPs depress me, do you think I could have a personal injury claim against the Ministry?

Thanks, I feel much better now.

Dr Andrew Brown said...

Antigonos & Anonymous: thanks for your comments, and keep your chins up!