Distilling the PHQ-9
Answering with a scale from 0 to 3 how you cope with a daily activity can be reasonably straightforward. But over time, the survey becomes more challenging, especially the questions regarding personal beliefs:
6. Over the last two weeks, how often have you felt that you are a failure or have let yourself or your family down?
9. Over the last two weeks, how often have you thought that you would be better off dead?
On question 7 (Trouble concentrating on things, such as reading the newspaper or watching television), the PHQ-9 implies that depression can cause difficulties focusing. The impediment is caused by the prefrontal cortex freezing when we go into fight, flight or freeze mode. This part of the brain is responsible for reading, math, and other deep thinking.
When we struggle to focus on reading, we tend to skim, seeking specific information or the general idea of the content. The 1st time I did the test, I could read all of it with no issues. Once it became a regular thing, I started scanning through for the key points.
At one stage, I could only see two questions:
- Have you let yourself or your family down?
- Would you be better off dead?
The prefrontal cortex’s coping mechanism affecting focusing explains how I read the PHQ-9 as two questions. And the constant repetition of these did become a mantra, making them seem like assertions to me. But that was my personal experience. I still need to test the test through a less subjective method to see if the risk is there.
Seeking its core query, I’ve distilled the PHQ-9 through a refining system that consists of deleting five words at a time (six on the first stage to round it down to 100) without altering the text’s meaning. Once I reached the minimum amount of words per question, I started removing the less triggering questions.
The final five words left say: would be better off dead. According to this, if we were to sum up the PHQ-9 in a single question (PHQ-1), it would be:
Do you think you would be better off dead?
For me, this was a suicide reminder. However, I did discuss it with a psychologist to hear their thoughts. We concluded that despite the new question losing its initial frequency measuring purpose (Over the last two weeks, how often) and becoming a binary choice – there is still a choice. There is the ‘NO’ option. What the PHQ-1 in disguise checks is whether the patient feels suicidal or not. The thing is that the question itself can boost how they feel. It might remind patients of their suicidal ideations, but it can also reaffirm the will to live if they’re experiencing progress. Either way, it reinforces their direction, which could affect their progress positively, but also comes with the risk of strengthening their suicidal side.