D0500: Staff Assessment of Resident Mood (PHQ-9-OV©)

 

Item Rationale

Health-related Quality of Life

• PHQ-2 to 9© Resident Mood Interview is preferred as it improves the detection of a possible mood disorder. However, a small percentage of residents are unable or unwilling to complete the PHQ-2 to 9© Resident Mood Interview. Therefore, staff should complete the PHQ-9© Observational Version (PHQ-9-OV©) Staff Assessment of Mood in these instances so that any behaviors, signs, or symptoms of mood distress are identified.

• Persons unable to complete the PHQ-2 to 9© Resident Mood Interview may still have a mood disorder.

• Even if a resident was unable to complete the Resident Mood Interview, important insights may be gained from the responses that were obtained during the interview, as well as observations of the resident’s behaviors and affect during the interview.

• The identification of symptom presence and frequency as well as staff observations are important in the detection of mood distress, as they may inform need for and type of treatment.

• It is important to note that coding the presence of clinical signs and symptoms of depressed mood does not automatically mean that the resident has a diagnosis of depression or other mood disorder. Assessors do not make or assign a diagnosis as a result of the outcomes of the PHQ-2 to 9© or the PHQ-9-OV©; they simply record the presence or absence of specific clinical signs and symptoms of depressed mood.

• Alternate means of assessing mood must be used for residents who cannot communicate or refuse or are unable to participate in the PHQ-2 to 9© Resident Mood Interview. This ensures that information about their mood is not overlooked.

Planning for Care

• When the resident is not able to complete the PHQ-2 to 9©, scripted interviews with staff who know the resident well should provide critical information for understanding mood and making care planning decisions.

Steps for Assessment

Conduct the interviews during the 7-day look-back period based on the ARD.

1. Interview staff from all shifts who know the resident best. Conduct interview in a location that protects resident privacy.

2. Many of the same administration techniques outlined above for the PHQ-2 to 9© Resident Mood Interview and Interviewing Tips & Techniques can be followed when staff are interviewed.

3. Encourage staff to report symptom frequency, even if the staff believes the symptom to be unrelated to depression.

4. Explore unclear responses, focusing the discussion on the specific symptom listed on the assessment rather than expanding into a lengthy clinical evaluation.

5. If frequency cannot be determined by staff interview because the resident has been in the facility for less than 2 weeks, talk to family or significant other and review transfer records to inform the selection of a frequency code.

 

Examples of Staff Responses That Indicate Need for Follow-up Questioning with the Staff Member

1. D0500A, Little Interest or Pleasure in Doing Things

• The resident doesn’t really do much here.

• The resident spends most of the time in their room.

2. D0500B, Feeling or Appearing Down, Depressed, or Hopeless

• They’re 95—what can you expect?

• How would you feel if you were here?

3. D0500C, Trouble Falling or Staying Asleep, or Sleeping Too Much

• Their back hurts when they lie down.

• They urinate a lot during the night.

4. D0500D, Feeling Tired or Having Little Energy

• They’re 95—they’re always saying they’re tired.

• They’re having a bad spell with their COPD right now.

5. D0500E, Poor Appetite or Overeating

• They have not wanted to eat much of anything lately.

• They have a voracious appetite, more so than last week.

6. D0500F, Indicating That They Feel Bad about Self, Are a Failure, or Have Let Self or Family Down

• They do get upset when there’s something they can’t do now because of their stroke.

• They get embarrassed when they can’t remember something they think they should be able to.

7. D0500G, Trouble Concentrating on Things, Such as Reading the Newspaper or Watching Television

• They say there’s nothing good on TV.

• They never watch TV.

• They can’t see to read a newspaper.

8. D0500H, Moving or Speaking So Slowly That Other People Have Noticed. Or the Opposite—Being So Fidgety or Restless That They Have Been Moving Around a Lot More than Usual

• Their arthritis slows them down.

• They’re bored and always looking for something to do.

9. D0500I, States That Life Isn’t Worth Living, Wishes for Death, or Attempts to Harm Self

• They say God should take them already.

• They complain that people were not meant to live like this.

10. D0500J, Being Short-Tempered, Easily Annoyed

• They’re OK if you know how to approach them.

• They can snap but usually when their pain is bad.

• Not with me.

• They’re irritable.

Coding Instructions for Column 1. Symptom Presence

• Code 0, no: if symptoms listed are not present. Enter 0 in Column 2, SymptomFrequency.

• Code 1, yes: if symptoms listed are present. Enter 0, 1, 2, or 3 in Column 2, Symptom Frequency.

Coding Instructions for Column 2. Symptom Frequency

• Code 0, never or 1 day: if staff indicate that the resident has never or has experienced the symptom on only 1 day.

• Code 1, 2-6 days (several days): if staff indicate that the resident has experienced the symptom for 2-6 days.

• Code 2, 7-11 days (half or more of the days): if staff indicate that the resident has experienced the symptom for 7-11 days.

• Code 3, 12-14 days (nearly every day): if staff indicate that the resident has experienced the symptom for 12-14 days.

Coding Tips and Special Populations

• Ask the staff member being interviewed to select how often over the past 2 weeks the symptom occurred. Use the descriptive and/or numeric categories on the form (e.g., “nearly every day” or 3 = 12-14 days) to select a frequency response.

• If you separated a longer item into its component parts, select the highest frequency rating that is reported.

• If the staff member has difficulty selecting between two frequency responses, code for the higher frequency.

• If the resident has been in the facility for less than 2 weeks, also talk to the family or significant other and review transfer records to inform selection of the frequency code.