D0160: Total Severity Score

D0160: Total Severity Score

Item Rationale

Health-related Quality of Life

• The Total Severity Score is a summary of the frequency scores on the PHQ-2 to 9© that indicates the extent of potential depression symptoms.

• The Total Severity Score does not diagnose a mood disorder or depression but provides a standard score which can be communicated to the resident’s physician, other clinicians and mental health specialists for appropriate follow up.

Planning for Care

• The PHQ-2 to 9© Total Severity Score also provides a way for health care providers and clinicians to easily identify and track symptoms and how they are changing over time.

• Responses to PHQ-2 to 9© can indicate possible depression if the full PHQ-2 to 9© is completed (i.e., interview is not stopped after D0150B due to responses). Responses can be interpreted as follows:

— Major Depressive Syndrome is suggested if—of the 9 items—5 or more items are identified at a frequency of half or more of the days (7-11 days) during the assessment period.

— Minor Depressive Syndrome is suggested if, of the 9 items, (1) feeling down, depressed or hopeless, (2) trouble falling or staying asleep, or sleeping too much, or (3) feeling tired or having little energy are identified at a frequency of half or more of the days (7-11 days) during the assessment period.

— In addition, PHQ-2 to 9© Total Severity Score can be used to track changes inseverity over time. Total Severity Score can be interpreted as follows:

1-4: minimal depression

5-9: mild depression

10-14: moderate depression

15-19: moderately severe depression

20-27: severe depression

Steps for Assessment

After completing D0150 A–I

1. Add the numeric scores across all frequency items in Resident Mood Interview (D0150) Column 2.

2. Do not add up the score while you are interviewing the resident. Instead, focus your full attention on the interview.

3. The maximum resident score is 27 (3 x 9).

Coding Instructions

• If only the PHQ-2© is completed because both D0150A1 and D0150B1 are coded 9, leave D0150A2 and D0150B2 blank, then end the PHQ-2© and leave D0160-Total Severity Score blank.

• If only the PHQ-2© is completed because both D0150A2 and D0150B2 are scored 0 or 1, add the numeric scores from these two frequency items and enter the value in D0160.

• If the PHQ-9© was completed (that is, D0150C–I were not blank due to the responses in D0150A and B) and if the resident answered the frequency responses of at least 7 of the 9 items on the PHQ-9©, add the numeric scores from D0150A2–D0150I2, following the instructions in Appendix E, and enter in D0160.

• If symptom frequency in items D0150A2 through D0150I2 is blank for 3 or more items, the interview is deemed NOT complete. Total Severity Score should be coded as “99” and the Staff Assessment of Mood should be conducted, unless the assessment being completed is a stand-alone Part A PPS Discharge; if that is the case, then skip to D0700. Social Isolation.

• Enter the total score as a two-digit number. The Total Severity Score will be between 00 and 27 (or “99” if symptom frequency is blank for 3 or more items).

• The software will calculate the Total Severity Score. For detailed instructions on manual calculations and examples, see Appendix E: PHQ-2 to 9© Total Severity Score Scoring Rules.