2021 Award Winner Non-Research Non-Teaching Hospital Health System


Oceans Behavioral Health Hospital, Abilene

Project: Patient Health Questionnaire (PHQ-9)

Oceans Behavioral Hospital Abilene provides inpatient and outpatient mental health care to adolescents, adults and seniors. The hospital serves the Abilene community and surrounding rural areas, filling a critical gap in the local health care continuum.

As part of an organization-wide quality improvement initiative in 2020, Oceans Abilene began collecting, analyzing and reporting data related to their use of the Patient Health Questionnaire (PHQ-9) to screen for and measure depression levels in patients. The PHQ-9 is a screening tool associated with the Joint Commission’s National Patient Safety Goal for Suicide Prevention. In addition to diagnosing and monitoring the severity of a patient’s depression, the PHQ-9 also screens for the presence and duration of suicidal ideation. The use of this tool has been essential in ensuring patients leave treatment better than when they entered while providing a much-needed standardized quality measure for behavioral health care, which lacks many of the empirical tools used in physical health care.

Members of the Oceans Behavioral Health Team, standing from left to right: Danny Miller, Stacey Sanford, Alexandra Walters, Sydne Valentine, Chris Stephenson, Terry Burke, Kenzie Gilchrist, Tana Barron, Rick Walters, Edwin Akwanga and Britany Leggett. Seated from left to right: Kelli Garrett, Chasidy Tomlin, Kirk Hancock and Alyssa Holden.

Beginning in July 2020, Oceans Abilene administered 1,086 questionnaires to patients over the course of a year. The assessment showed that 595 of those patients (55%) were experiencing severe depression symptomology at admission. While the dataset was formatted to screen out initial scores of minimal depression, notably, all of the screened patients in Q1 and Q2 of 2021 reported a severity level of at least moderate depression or above, and only 5% (53) characterized initial depression levels as mild in Q3 and Q4 of 2020.

Over the course of treatment, which averaged 9.91 days for all age groups, the average PHQ-9 score fell from 19.52 at admission to 3.67 at discharge – an 81% reduction in depression symptomology.


  • The percentage of patients reporting severe levels of depression fell from 53% at admission to 1% at discharge. 
  • At discharge, only 9% of patients characterized their depression as moderate or moderately severe – compared with 39% of patients at admission.
  • 90% of patients were discharged with the lowest level of mild to minimal depression.

To ensure continued improvement in quality measurement and patient safety, PHQ-9 outcome information is reviewed by the medical staff’s Quality Assessment and Performance Improvement Committee on a regular basis. Updates and suggestions for change are considered in the committee and then presented to the Governing Board for full approval.