Patient activation, depression and quality of life

Patient Educ Couns. 2014 Mar;94(3):432-7. doi: 10.1016/j.pec.2013.10.015. Epub 2013 Nov 5.


Objective: "Patient activation" describes the extent to which individuals manage their own healthcare. This study evaluated the association of patient activation, depressive symptoms and quality of life in a primary care setting.

Methods: 278 patients who visited two primary care clinics were interviewed in the waiting room before their appointment or by telephone. Study participants completed the Patient Activation Measure (PAM), Patient Health Questionnaire-9 (PHQ-9) and Short Form-12 Health Survey (SF-12). Physicians assessed each participant's depression status immediately after the visit.

Results: PAM scores correlated negatively with PHQ-9 (r=-0.35, p<0.0001) and positively with total SF-12 score (r=0.39, p<0.0001). Increased participant involvement by one-level increments on the PAM was predicted by their being in the 55 to 74-year age group and higher total SF-12 quartiles. Almost half of those scoring ≥10 on PHQ-9 were not considered depressed by their physician (false negatives, i.e. "hidden depression").

Conclusion: In primary care settings, PAM is easily administered and useful for general patients and for those with depressive symptoms.

Practice implications: Assessing patient activation will enable caregivers to monitor levels of self-care (activation) and potential adherence to health behavior recommendations. PHQ-9 screening could increase awareness of "hidden depression" in the primary care setting.

Keywords: Depression; PHQ-9; Patient Activation Measure (PAM); Primary care; SF-12.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Cross-Sectional Studies
  • Depression / diagnosis*
  • Female
  • Health Surveys
  • Humans
  • Israel
  • Male
  • Mass Screening
  • Middle Aged
  • Patient Participation*
  • Primary Health Care
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Quality of Life*
  • Self Care / psychology*
  • Surveys and Questionnaires*