Abstract Background Implementation of routine screening for depression in patients with inflammatory bowel disease (IBD) is recommended by clinical guidelines for IBD management.1-3 In one study, the Patient Health Questionnaire-9 (PHQ-9) had the highest sensitivity among depression scales.4 However, a subset of the PHQ-9, the PHQ-2, is often utilized in clinical settings due to brevity. Here, we compare performances of these two depression screening tools in patients with IBD treated in our tertiary care clinic. Methods We conducted a retrospective cohort study of adult patients with IBD who were treated in our tertiary care clinic and screened for depression using the PHQ-9 between March 2023 and May 2025. PHQ-2 scores were calculated based on results of patients’ PHQ-9 responses. Mental health screening results, demographics, disease characteristics, symptomatic disease activity, and biochemical markers of inflammation were collected. Clinically active IBD was defined as Harvey-Bradshaw Index (HBI) 5 for Crohn’s disease and Simple Clinical Colitis Activity Index (SCCAI) 2 for ulcerative colitis. Results A total of 379 patients with IBD (250 (66%) Crohn’s, 210 (55%) Female, 308 (81%) White, median age 42 (IQR 31-59)) were included. Rates of depressive symptoms among the entire cohort were categorized according to standard PHQ-9 scoring and are as follows: 231 minimal (60.9%), 95 mild (25.1%), 37 moderate (9.8%), 11 moderately severe (2.9%), and 5 severe (1.3%). Based on the PHQ-2 scores we calculated for these 379 patients, 46 (12.1%) would have screened positive for depression, and 333 (87.9%) would not have screened positive. Among these 333 patients who would not have screened positive by the PHQ-2 alone, 19 (5.7%) were classified as having moderate or higher depressive symptoms by the PHQ-9, including 2 (0.6%) who reported several days of suicidal ideation (Fig. 1). Conclusion We identify potential drawbacks of using the PHQ-2 instead of the PHQ-9 to screen for depression in patients with IBD, specifically the potential to miss a small, but important group who do endorse meaningful depressive symptoms and/or suicidal ideation. While expediency and efficiency are needed in busy clinical practices, limitations to such approaches are critical to understand. References: 1. Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, Bamias G, Barreiro-de Acosta M, Braithwaite T, Greuter T, Harwood C, Juillerat P, Lobaton T, Müller-Ladner U, Noor N, Pellino G, Savarino E, Schramm C, Soriano A, Michael Stein J, Uzzan M, van Rheenen PF, Vavricka SR, Vecchi M, Zuily S, Kucharzik T. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2024;18(1):1-37. 2. Rubin DT, Ananthakrishnan AN, Siegel CA, Barnes EL, Long MD. ACG Clinical Guideline Update: Ulcerative Colitis in Adults. Am J Gastroenterol. 2025;120(6):1187-1224. 3. Lichtenstein GR, Loftus EV, Afzali A, Long MD, Barnes EL, Isaacs KL, Ha CY. ACG Clinical Guideline: Management of Crohn’s Disease in Adults. Am J Gastroenterol. 2025;120(6):1225-1264. 4. Bernstein CN, Zhang L, Lix LM, Graff LA, Walker JR, Fisk JD, Patten SB, Hitchon CA, Bolton JM, Sareen J, El-Gabalawy R, Marriott J, Marrie RA; CIHR Team in Defining the Burden and Managing the Effects of Immune-mediated Inflammatory Disease. The Validity and Reliability of Screening Measures for Depression and Anxiety Disorders in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2018;16;24(9):1867-1875. Conflict of interest: Ms. Mcdermott, Alexandra: No conflict of interest Bedell, Alyse R.: Grant support from Pfizer Light, Sophia W.: No conflict of interest Schmaus, Jennifer A.: No conflict of interest Rubin, David T.: Grant support: Takeda Pharmaceuticals Consultant: Abbvie, Abivax SA, Altrubio, Athos Therapeutics, Inc, Bristol-Myers Squibb, Celltrion, Connect BioPharma, Eli Lilly & Co., Genentech (Roche) Inc., Iterative Health, Janssen Pharmaceuticals, Johnson & Johnson, Merck & Co., Mirador, Odyssey Therapeutics, Pfizer, Sanofi, Spyre, Takeda Pharmaceuticals, Vedanta Biosciences, and Ventyx.
McDermott et al. (Thu,) studied this question.