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Considering psychological factors

Learn to consider the psychological in a patient interview

It is worth listening to the language that the patient uses to describe themselves or their eating behaviours to gauge the extent to which they may have internalised negative stereotypes of obesity (internalised weight bias).

Formal assessment of depression may also be required given that depression is a common co-morbidity in people with overweight or obesity. The Patient Health Questionnaire-2 (PHQ-2) is a very brief screening tool that can be used in the clinical setting.1 A negative result to both questions is considered a negative result for depression. If a patient has a positive response to one or both questions, then a more detailed screening tool such as the Patient Health Questionnaire-9 (PHQ-9)2 can be administered. This can help guide medical referral for follow-up. You can download a hard copy or view copies of the questionnaires below: Other psychological factors that you should consider in your assessment include pain catastrophising, fear of movement and low self efficacy (low confidence).

Screen grab of Patient Health Questionnaire-2: Screening Instrument for Depression. Over the past two weeks, how often have you been bothered by any of the following problems. Scale: Not at all 0, Several days 1, 2 More than one-half the days, 3 Nearly every day. Little interest or pleasure in doing things. Feeling down, depressed, or hopeless.

Screen grab of Patient Health Questionnaire-9: Screening Instrument for Depression. Over the past two weeks, how often have you been bothered by any of the following problems. Scale: Not at all 0, Several days 1, 2 More than one-half the days, 3 Nearly every day. Little interest or pleasure in doing things. Feeling down, depressed, or hopeless. Trouble falling or staying asleep, or sleeping too much. Feeling tired or having little energy. Poor appetite or overeating. Feeling bad about yourself-or that you are a failure or have let yourself or your family down. Trouble concentrating on things, such as reading the newspaper or watching television. Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that you have been moving around a lot more than usual. Thoughts that you would be better off dead, or of hurting yourself in some way.

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EduWeight: Weight Management for Adult Patients with Chronic Disease

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