Table 4 Participants’ Feedback on Acceptability of the PHQ-9

PHQ002

This is a confusing question. What does ‘acceptable’ mean? I don’t mind answering the questions, but then again I wasn’t ticking ‘nearly every day’ for every statement so I might feel it’s more intrusive if that was the case. Q16 is also not very well designed. The scale should have a mid-point and a don’t know option!

PHQ004

Not enough range between ‘1’ and ‘several days’. Also, more choice between ‘thoughts of being dead or hurting myself’ which might include feeling a range of guilt rather than wanting to die.

PHQ010

Would like another option for 1 or 2 days. Several days feels like too many but 1 is not true.

For some things I needed a category of 1 or 2. 1 isn’t the case but ‘several days’ feels like too much.

PHQ023

Question 5 and 6 about depression doesn’t allow for context which may affect the data you’re collecting and your results. E.g. I am on medicine for depression but the depression is a result of fatigue. So my answers to questions D) and further questions may not be correlated to ‘usual/classic’ symptoms of depression. Hopefully this is ok for your survey.

PHQ028

Asking if you are better or dead or hurting yourself is a very grim thought to think about and put yourself in - not very appropriately.

PHQ032

there is not a choice for occasionally. I think it made me more depressed than I’ve ever been.

It seems to accentuate the negative and filling it in as best as I could makes my me sound more “down” that I actually am!

PHQ035

if you answer no, then you should skip to the next appropriate question

PHQ041

Two points. 1. No opportunity to refer to other possible current “depression " triggers − 2. Question 16 did not offer a choice between frequency of “1 " and “several days”. Personally 3–12 h would have suited frequencies which I necessarily chose as “several days”. Possibly nitpicking, but the difference between 1 and for a short period I should have thought is more significant than a difference of degree.

PHQ045

I think there needs to be another option in the choices of “occasionally” in between 1 and several days - I felt that sometimes I wanted to answer between the 2 options

the survey needed a fifth option, between “1” and “several days” - occasionally. there were some questions that I felt I wanted to say I had experienced the situation over the 2 weeks, but several days seemed too frequent.

PHQ047

It was acceptable but as there were only 4 points to the scale I often had to settle for the nearest one when I perhaps would have preferred more options

PHQ060

Would have liked a ‘one or two days’ option.

Think I said before, but think there should be an option between ‘1’ and ‘Several days’; e.g. ‘One or two days’.

PHQ063

Does not pick up variability in symptoms (e.g. fatigue) & resulting effects on mood, ability to cope, sense of isolation.

Not detailed enough to pick up complex interactions/connections between physical state of health & mood/mental health (e.g. effects of isolation due to physical state on mood).

PHQ073

May be easily attributed to busy schedule rather than MS/depression -- some way of discriminating between the two might be useful.

PHQ076

there is a huge gap between ‘1’ and ‘several days’. for example, I felt tired for a short time, not even one day though.

I find that I experience the feelings described occasionally, for very short periods of time, so until this 3rd questionnaire I have always answered 1. This is because I do not suffer any of them for whole days, or even parts of days. Rather, only a few minutes at a time. I felt I should register these feelings so have used the first column this time. It would have been more helpful to have possible selections such as ‘ever’, ‘often’, ‘frequently’ etc.

PHQ087

Need more options or space to qualify statement

PHQ098

4 years of psychotherapy means no question is odd or bad!!

No questions inappropriate - more that it’s so very general

PHQ107

Range of days in D would be helpful. One day is neither ‘several’ or ‘1’

PHQ111

Is there a suggestion that I should feel depressed?

PHQ118

Every day should also be an option An additional question asking how much the way we are feeling is because of our MS would be 2

PHQ123

I feel the categories for the current mood question were too wide.

PHQ124

I wondered about the ‘better off dead’ aspect. I think it is different from thoughts of ending one’s life, is this difference intentional? I also think it is quite suggestive to people with a new diagnosis, or a recent relapse, for example. Perhaps thoughts that life is not worth living would be a better way to phrase this. I just find it slightly insensitive.

PHQ125

How certain questions are asked. For example, when asking about my general health does this mean excluding my MS?

PHQ139

It made me think that should I have these thoughts.