Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS)

The percentage of members 12 years of age and older with a diagnosis of major depression or dysthymia who had an outpatient encounter with a PHQ-9 score present in their record in the same assessment period as the encounter.

Learn more about NCQA depression measures.

Why It Matters

Major depressive disorder (MDD) is the second leading cause of disability worldwide, affecting an estimated 120 million people. 1 The lifelong prevalence is estimated to range from 10%–15%. 2 In the United States, 16% of people report that at some point in their lifetime they were told by a health care professional that they had depression. 3

In adolescents, depression can also result in serious long-term morbidities such as generalized anxiety disorder and panic disorder, or lead to engagement in risky behaviors such as substance use. 4, 5, 6, 7 Adolescent-onset depression increases the risk of attempted suicide five-fold in comparison with nondepressed adolescents. 8 Most adolescents who commit suicide, the third leading cause of death among 15–24 year-olds, have a history of depression. 9

Perinatal depression refers to minor and major depression episodes during pregnancy and/or the first 12 months after childbirth and is a common condition that affects functional outcomes both for affected women and for their families.10 Rates of depression for pregnant and/or postpartum women range from 12%-15%, with postpartum depression rates in some U.S. areas estimated to be as high as 20%.11 Women with untreated depression during pregnancy are at risk for developing severe postpartum depression and suicidality, and of delivering premature or low birth-weight infants. 12 Postpartum depression hinders important caregiving activities and infant attachment and bonding, which can lead to developmental disorders that last into adolescence. 13, 14, 15

Studies have found that patient outcomes improve when there is collaboration between a primary care provider, case manager and a mental health specialist to screen for depression, monitor symptoms, provide treatment and refer to specialty care as needed.  16, 17, 18

* Adapted with financial support from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) under the CHIPRA Pediatric Quality Measures Program Centers of Excellence grant number U18HS020503, and with permission from the measure developer, Minnesota Community Measurement.

For more information on this measure, please visit the NCQA depression measures webpage.


NCQA published a special report summarizing HEDIS measurement year 2020 results for eight measures that leverage electronic clinical data, including this measure. This report can be found here: www.ncqa.org/ecds.


  1. Murray, C.J.L., T. Vos, R. Lozano, M. Naghavi, A.D. Flaxman, C. Michaud, M. Ezzati, et al. 2013. “Disability-Adjusted Life Years (DALYs) for 291 Diseases and Injuries in 21 regions, 1990–2010: a Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380(9859):2197–23.
  2. Lépine, J.P., M. Briley. 2011. “The Increasing Burden of Depression.” Neuropsychiatric Disease and Treatment 7(suppl 1):3–7.
  3. Centers for Disease Control and Prevention. 2009. “Anxiety and Depression Effective Treatments Exist: People with Depression and Anxiety Should Seek Help as Early as Possible to Reduce Health Effects and Improve Quality of Life. Based on 2006 Behavior Risk Factor Surveillance System.” www.cdc.gov/Features/dsBRFSSDepressionAnxiety
  4. Taylor, E. et al. 1996. “Hyperactivity and Conduct Problems as Risk Factors for Adolescent Development.” Journal of the American Academy of Child and Adolescent Psychiatry 35:1213–26.
  5. Foley, H.A., C.O. Carlton, R.J Howell. 1996. “The Relationship of Attention Deficit Hyperactivity Disorder and Conduct Disorders to Juvenile Delinquency: Legal Implications.” Bulletin of the American Academy of Psychiatry Law 24:333–45.
  6. Friedman, R.M., J.W. Katz-Levey, R.W Manderschied, D.L. Sondheimer. 1996. “Prevalence of Serious Emotional Disturbance in Children and Adolescents.” In: Manderscheid, R.W., and M.A. Sonnenschein (eds.) Mental Health. United States. Rockville, MD: Center for Mental Health Services, 71-8.
  7. O’Connell, M.E., Boat, T., Warner, K.E. 2009. “Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and possibilities.” National Research Council and Institute of Medicine. http://www.whyy.org/news/sci20090302Mentalprepub.pdf
  8.  Garber, J. et al. 2009. “Prevention of Depression in At-Risk Adolescents: A Randomized Controlled Trial.” Journal of the American Medical Association 301(21):2215–24.
  9. Williams, S.B., E.A. O’Connor, M. Eder, E.P. Whitlock. 2009. “Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force.” Pediatrics 123(4):e716-e735.
  10. Gaynes, B.N., N. Gavin, S. Meltzer-Brody, et al. 2005. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes: Summary. Bethesda, MD: National Center for Biotechnology Information, 2005: 1–8.
  11. Ko, J.Y., K.M. Rockhill, V.T. Tong, B. Morrow, S.L. Farr. 2017. “Trends in Postpartum Depressive Symptoms—27 States, 2004, 2008, and 2012.” MMWR Morb Mortal Wkly Rep 66: 153–8. doi: http: //dx.doi.org/10.15585/mmwr.mm6606a1.
  12. Chan, J., A. Natekar, A. Einarson, and G. Koren. 2014. “Risks of Untreated Depression in Pregnancy.” Can Fam Physician Mar; 60(3): 242–3.
  13. Field, T. 2010. “Postpartum Depression Effects on Early Interactions, Parenting, and Safety Practices: A Review.” Infant Behav Dev 33(1): 1–6.
  14. Gregory, E.F., A.M. Butz, S.R. Ghazarian, S.M. Gross, S.B. Johnson. 2015. “Are Unmet Breastfeeding Expectations Associated With Maternal Depressive Symptoms?” Acad Ped 15(3): 319–25.
  15. Kingston D., S. Tough, H. Whitfield. 2012. “Prenatal and Postpartum Maternal Psychological Distress and Infant Development: A Systematic Review.” Child Psychiatry and Human Development 43(5): 683–714.
  16. Von Korff, M., D. Goldberg. 2001. “Improving Outcomes in Depression.” British Medical Journal 323:948–9.
  17. Gilbody, S., P. Bower, J. Fletcher, D. Richards, A.J. Sutton. 2006. “Collaborative Care for Depression: A Cumulative Meta-Analysis and Review of Longer-Term Outcomes.” Archives of Internal Medicine 166(21):2314–21.
  18. Thota, A.B., T.A. Sipe, G.J. Byard, C.S. Zometa, R.A. Hahn, L.R. McKnight-Eily, D.P. Chapman et al. 2012. “Collaborative Care to Improve the Management of Depressive Disorders: A Community Guide Systematic Review and Meta-Analysis.” American Journal of Preventive Medicine 42(5):525–38.
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