Patient Health Questionnaire‑15 (PHQ‑15)
Study Notes: Disorder‑Specific Severity Measures for Adults
Focus: Level 2—Somatic Symptom—Adult (PHQ‑15)
1. Introduction
Somatic symptoms are physical complaints that may or may not have a clear medical explanation.
They are common in primary care and psychiatric settings and can lead to significant distress and functional impairment.
The Patient Health Questionnaire‑15 (PHQ‑15) is a widely used, validated self‑report measure that assesses the severity of somatic symptoms in adults.
It is part of the broader PHQ series, which includes tools for depression (PHQ‑9), anxiety (GAD‑7), and other conditions.
The PHQ‑15 is particularly useful in identifying somatic symptom disorder (SSD) and related conditions, as described in DSM‑5.
2. Understanding Somatic Symptom Disorder
Definition
SSD is characterized by one or more distressing somatic symptoms that are persistent and accompanied by excessive thoughts, feelings, or behaviors related to the symptoms.
Symptoms may include pain, fatigue, gastrointestinal issues, or neurological complaints.
Key Features
Symptoms last for at least 6 months.
Excessive concern about health and symptoms.
High healthcare utilization.
Functional impairment in daily life.
Impact
SSD and related conditions are associated with increased medical costs, reduced quality of life, and comorbid psychiatric disorders (depression, anxiety).
They are common in primary care, accounting for a significant proportion of visits.
3. The PHQ‑15
Purpose
Designed to quantify severity of somatic symptoms in adults.
Used for screening, diagnosis support, and monitoring treatment progress.
Provides a patient‑centered perspective on physical complaints.
Structure
Self‑report questionnaire with 15 items.
Each item asks about the severity of a specific somatic symptom over the past 4 weeks.
Response scale:
0 = Not bothered at all
1 = Bothered a little
2 = Bothered a lot
Domains Assessed
Pain (stomach pain, back pain, headaches).
Gastrointestinal symptoms (nausea, constipation, diarrhea).
Cardiopulmonary symptoms (shortness of breath, chest pain).
Neurological symptoms (dizziness, fainting).
General symptoms (fatigue, sleep problems, menstrual issues).
4. Scoring and Interpretation
Raw Scores
Each item scored 0–2; total raw score range = 0–30.
Clinical Interpretation
Total Score Severity Level Clinical Interpretation
0–4 Minimal No significant somatic symptoms
5–9 Low Mild somatic symptom severity
10–14 Medium Moderate severity; consider further evaluation
15–30 High High severity; likely somatic symptom disorder
Clinical Use
Higher scores indicate greater impairment.
Scores guide treatment planning (e.g., psychotherapy, medical evaluation).
Repeated administration tracks progress over time.
5. Advantages
Brief and easy to administer (5 minutes).
Validated across diverse populations.
Self‑report format empowers patients.
Disorder‑specific: focuses on somatic symptoms rather than general distress.
Useful for monitoring treatment outcomes longitudinally.
6. Limitations
Relies on self‑report, which may be influenced by bias.
May not capture cultural variations in symptom expression.
Requires clinical judgment to interpret results.
Not a substitute for a comprehensive diagnostic interview.
7. Clinical Applications
Screening
Identifies adults at risk for somatic symptom disorder in primary care or psychiatric settings.
Monitoring
Tracks symptom changes during psychotherapy, pharmacotherapy, or lifestyle interventions.
Research
Provides standardized data for clinical trials and epidemiological studies.
8. Integration with Value‑Based Care
Aligns with value‑based care models by providing measurable outcomes.
Supports quality improvement initiatives in mental health services.
Facilitates population health management by identifying high‑risk groups.
9. Alignment with IOM Six Aims
Safe: Identifies severe somatic symptoms early, preventing harm.
Effective: Evidence‑based tool validated in multiple studies.
Patient‑Centered: Self‑report respects patient voice.
Timely: Quick administration reduces delays in diagnosis.
Efficient: Minimizes resource use compared to lengthy interviews.
Equitable: Adaptable to diverse populations and languages.
10. Country Comparison: United States vs Kenya
United States
PHQ‑15 integrated into electronic health records.
Used in primary care, psychiatry, and psychology.
Supported by insurance reimbursement for screening.
Kenya
Growing recognition of somatic symptom disorders as public health issues.
Challenges: limited mental health professionals, stigma, resource constraints.
PHQ‑15 valuable for task‑shifting to community health workers.
Translation and cultural adaptation ongoing.
11. Case Example
Patient O: 45‑year‑old reporting fatigue, headaches, and gastrointestinal distress.
PHQ‑15 score = 18 → High severity.
Intervention: CBT focusing on symptom management + medical evaluation.
Follow‑up score after 12 weeks = 8 → Low severity, showing improvement.
12. Future Directions
Digital administration via apps and telehealth platforms.
Integration with wearable devices for real‑time monitoring of physical symptoms.
Use in global mental health initiatives to standardize measurement.
Expansion to cross‑cultural validation studies.
13. Conclusion
The PHQ‑15 is a valuable tool for assessing and monitoring somatic symptoms in adults.
Its brevity, validity, and adaptability make it indispensable in clinical practice and research.
When combined with disorder‑specific severity measures, value‑based care, and IOM aims, it enhances the quality and equity of health services globally.
15‑Question Quiz: PHQ‑15 Somatic Symptom Severity Scale
What does the PHQ‑15 primarily assess?
a) General anxiety symptoms
b) Somatic symptom severity
c) Depression severity
d) Bipolar disorder symptoms
Answer: b
How many items are included in the PHQ‑15?
a) 5
b) 9
c) 15
d) 20
Answer: c
What is the raw score range of the PHQ‑15?
a) 0–20
b) 0–30
c) 10–50
d) 5–25
Answer: b
Which score range indicates high severity?
a) 0–4
b) 5–9
c) 10–14
d) 15–30
Answer: d
Which domain is NOT assessed by the PHQ‑15?
a) Pain
b) Gastrointestinal symptoms
c) Cardiopulmonary symptoms
d) Appetite changes
Answer: d
Which IOM aim does the measure support by identifying severe somatic symptoms early?
a) Efficient
b) Safe
c) Timely
d) Equitable
Answer: b
Which advantage makes the PHQ‑15 widely used?
a) Long administration time
b) Requires specialist only
c) Brief and validated
d) Expensive licensing
Answer: c
Which limitation is most significant?
a) Too short
b) Self‑report bias
c) Requires lab tests
d) Not validated
Answer: b
Which country has integrated PHQ‑15 into electronic health records?
a) Kenya
b) United States
c) India
d) Brazil
Answer: b
Which country uses PHQ‑15 in community health programs despite resource constraints?
a) United States
b) Kenya
c) Germany
d) Japan
Answer: b
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