In Brief
Somatic symptoms can puzzle and distress both clients and therapists, often leaving clients feeling misunderstood and therapists searching for effective assessment tools. The Patient Health Questionnaire-15 (PHQ-15) offers a practical method for screening and tracking these physical symptoms in therapy. It should be noted that the PHQ-15 differs from the PHQ-9 and PHQ-2, which are common measures of depression symptoms.
Let’s take a detailed look at the PHQ-15, including its use, the insights it provides, the research backing its effectiveness, as well as common questions and suggestions for similar assessments to consider.
When do you use the Patient Health Questionnaire-15?
Therapists frequently use the PHQ-15 in both medical and mental health settings to screen for somatization and assess the severity of physical symptoms. It proves particularly helpful when assisting clients with somatic complaints linked to mental health conditions.
Associated focuses of treatment
Therapists often use the PHQ-15 to assess and treat somatic symptom disorder, anxiety disorders, and depressive disorders. It helps identify the presence and severity of somatic symptoms, guiding treatment planning and progress monitoring.
Age groups
The PHQ-15 targets adults aged 18 and older. While the PHQ-15 is not validated for use with young people aged 17 and below, the measure was adapted for this population. This tool is called the LEVEL 2—Somatic Symptom—Child Age 11–17 and is validated for use with youth aged 11-17.
Associated diagnoses
Therapists commonly use the PHQ-15 to assess and treat somatic symptom disorder, illness anxiety disorder, and other conditions with distressing physical symptoms. It also helps evaluate somatic symptoms related to anxiety disorders, depressive disorders, and trauma-related disorders.
Recommended frequency of use
Therapists typically administer the PHQ-15 monthly to track changes in somatic symptoms over time. However, the frequency may vary based on the client's specific needs and symptom severity. Regular monitoring with the PHQ-15 allows therapists to assess intervention effectiveness and adjust treatment plans as needed.
What do you learn from the Patient Health Questionnaire-15?
The PHQ-15 offers important insights into how somatic symptoms affect a client's life. Scores can show the level of somatic distress and help guide treatment choices. When scoring the measure, add up the sum of all responses. Total scores can range from 0 to 30
- Minimal somatic symptoms (score < 5): Low levels of somatic distress that might not need specific intervention beyond standard treatment for any underlying mental health conditions.
- Low somatic symptom severity (score 5-9): Mild somatic distress that may benefit from psychoeducation, stress management techniques, and monitoring.
- Medium somatic symptom severity (score 10-14): Moderate levels of somatic distress that likely require targeted interventions, such as cognitive behavioral therapy for somatic symptoms, relaxation training, or medication management.
- High somatic symptom severity (score ≥ 15): Severe somatic distress that calls for a comprehensive treatment approach, potentially including specialized care from a mental health professional experienced in treating somatic symptom disorders.
Administering the PHQ-15 over time allows you to track changes in somatic symptoms and assess treatment effectiveness. Consistently high or increasing scores may signal a need to re-evaluate the treatment plan, consider alternative interventions, or refer the client for further medical evaluation to rule out underlying physical health conditions.
Monitoring scores can also help identify patterns or triggers linked to somatic symptoms, informing targeted interventions and coping strategies. For example, if a client consistently reports increased symptoms during periods of high stress, therapy might focus on developing stress management and relaxation skills.
Research and Evidence behind the Patient Health Questionnaire-15
Kurt Kroenke, Robert L. Spitzer, and Janet B. W. Williams developed the PHQ-15 in the late 1990s as part of the broader Patient Health Questionnaire (PHQ) series. This series of self-administered questionnaires aimed to efficiently screen for common mental health disorders in primary care settings.
The PHQ-15 stands on a solid foundation of research supporting its validity and reliability:
- Validity: Studies consistently show that the PHQ-15 effectively measures the severity of somatic symptoms, demonstrating good construct validity. It also aligns well with other measures of somatization and physical health.
- Reliability: The PHQ-15 displays high internal consistency, across various studies, indicating that its items are closely related and measure the same underlying concept.
- Sensitivity to change: Research indicates that the PHQ-15 is sensitive to changes in somatic symptom severity over time, making it helpful for monitoring treatment progress.
While the PHQ-15 offers valuable insights, it's important to acknowledge its limitations:
- The questionnaire relies on self-report, which factors like recall bias or the client's willingness to disclose symptoms may influence.
- The PHQ-15 does not provide a definitive diagnosis of a somatic symptom disorder; it serves as a screening tool suggesting the need for further assessment.
- The measure does not differentiate between medically explained and unexplained symptoms, so a high score might reflect an underlying physical health condition rather than a somatic symptom disorder.
Despite these limitations, the PHQ-15 remains a widely used and well-validated tool for assessing somatic symptom severity in mental health settings. Its brevity, ease of administration, and strong psychometric properties make it a valuable resource for therapists working with clients experiencing distressing physical symptoms.
Frequently Asked Questions (FAQ)
When and where should I use the PHQ-15 with my clients?
The PHQ-15 is helpful when working with clients who report distressing physical symptoms that might relate to mental health issues like anxiety, depression, or somatic symptom disorders. Use it during intake assessments and throughout treatment to track changes in symptom severity. The PHQ-15 fits well in various settings, including primary care, mental health clinics, and hospitals.
How do I interpret the scores of the PHQ-15?
PHQ-15 scores range from 0 to 30, with higher scores indicating more severe somatic symptoms:
- Minimal severity (0-4): Somatic symptoms likely have minimal impact on the client's functioning and may not require specific intervention.
- Low severity (5-9): Mild somatic symptoms that might benefit from monitoring and psychoeducation.
- Medium severity (10-14): Moderate somatic symptoms that likely require targeted interventions like cognitive behavioral therapy or relaxation techniques.
- High severity (15-30): Severe somatic symptoms that may necessitate a comprehensive treatment approach, potentially including medication management or referral to a specialist.
Can I use the PHQ-15 to diagnose somatic symptom disorders?
While the PHQ-15 helps identify the presence and severity of somatic symptoms, it does not provide a definitive diagnosis of somatic symptom disorders. A high score suggests the need for further assessment, but a comprehensive evaluation is necessary for a formal diagnosis.
How often should I administer the PHQ-15?
Monthly administration of the PHQ-15 is recommended to regularly monitor symptom changes over time. However, therapists should use clinical judgement and adjust the frequency based on the client's specific needs and symptom severity.
Can the PHQ-15 distinguish between medically explained and unexplained symptoms?
No, the PHQ-15 does not separate symptoms with a clear medical cause from those without an identifiable physical explanation. A high score may indicate the presence of a physical health condition, a somatic symptom disorder, or a combination of both. Further medical evaluation may be necessary to rule out underlying physical health concerns.
Other Assessments and Worksheets to Consider
When assessing somatic symptoms, therapists may find it useful to incorporate other measures and client exercises alongside the PHQ-15 to gain a fuller picture of the client's experiences and inform treatment planning. Here is a complementary assessment and some client worksheets to keep in mind:
- Short Health Anxiety Inventory (SHAI): An 18-item measure that assesses health anxiety and related behaviors, like reassurance-seeking and body checking. The SHAI can identify clients who might benefit from treatments targeting health anxiety, such as cognitive behavioral therapy.
- Somatic Symptom Log: Helps track symptoms, including locations in the body, triggers/context, duration, and level of pain/discomfort.
- Somatic Symptom Scale-8 (SSS-8): A brief questionnaire that is used to assess the perceived burden of somatic symptoms.
Complementary assessments and exercises can offer valuable insights, but they should be used alongside other methods. Always consider the client's unique experiences, cultural background, and specific concerns when choosing and interpreting assessment tools. A comprehensive evaluation, including a clinical interview, behavioral observations, and input from other healthcare providers, can result in a more accurate understanding of the client's somatic symptoms and guide effective treatment planning.
