Is the PHQ9 Helpful in Identifying Depression Symptoms in Patients with HCV Infection?: 2133

Introduction: State reimbursable insurances require a self-assessed depression questionnaire for all patients attending outpatient clinic to identify and assess severity of depression. The Patient Health Questionnaire (PHQ9) is the preferred depression assessment tool by CMS. Patients scoring higher than 15 of 27 points must be referred to or be currently managed by psychiatric care. Patients with HCV are known to have a high prevalence of depression symptoms (27%) according to the literature. The aim of this study are: to review the performance of PHQ9 in patients with liver diseases and to examine how social and medical factors affect the variance in scores between patients with HCV. Methods: Between September 2014 and May 2015, 1005 consecutive patients attending a GI/Liver community clinic answered the PHQ9 questionnaire (521 females and 484 males, mean age 54.11). 309 patients have HCV (mean age is 55.99 ±9.43) among 122 females and 187 males. OLS regression models were calculated using 1) HCV status 2) age, sex, income, ethnicity and 3) co-morbidities to predict depression scores. Results: The mean PHQ9 score is 10.37 ±10.20; however for patients diagnosed with HCV, the mean score is 6.074 ±5.63. Only 10.3% of the sample has high depression scores. As shown in Table 1, three HCV diagnosis is associated with lower depression scores and is the strongest predictor of PHQ9 scores in all models. There is an inverse relationship between age and depression. Non-white patients are more likely to have higher depression scores. The number of co-morbidities is positively associated with depression scores (see table). Odds-Ratios show HCV patients are 74.2% less likely to have a PHQ9 score above 15. Patients over the mean age are 40% less likely to have a PHQ9 score above 15. Finally, patients with more than 3 comorbidities are 218% more likely to score above 15 on the PHQ9 when compared with non-HCV patients. Conclusion: We contend that the PHQ9 is under-estimating patient depression in patients with HCV. This could be related to: 1) patients are not taking the assessment seriously as they do not believe it matters in the care, 2) patients perceive the score as a potential obstacle to treatment, and 3) older patients believe that the label of depression is stigmatizing. In summary depression in HCV patients should be assessed with other well established instruments.