Objective:

Identify clinician-perceived barriers and facilitators that affect the systematic use of PHQ-9 depression screening of Multiple Sclerosis patients at Arrowhead Regional Medical Center (ARMC) Neurology clinic appointments.

Background:

Depression is common among people with Multiple Sclerosis (MS). Although the Patient Health Questionnaire-9 (PHQ-9) is validated for depression screening in MS populations, it is not routinely used in clinical settings, including at ARMC’s neurology clinic.

Design/Methods:

Neurologists at ARMC were invited to participate in a semi-structured interview. Questions investigated their familiarity with the PHQ-9, how often they use it clinically, and barriers or facilitators they can identify. Interview transcripts were reviewed and coded. Thematic analysis followed steps outlined by Braun & Clarke, including initial coding, theme development, and refinement.

Results:

While PHQ-9 depression screening was deemed clinically valuable, barriers to its consistent use exist. The primary barrier was structural workflow constraints, including limited visit time and competing clinical priorities. Knowledge gaps were prominent, with limited awareness and instruction in PHQ-9 use. Patient-specific challenges regarding MS, namely cognitive impairment, fatigue, mobility limitations, socioeconomic barriers, and language or literacy difficulties, further complicated screening. Proposed solutions included integrating screening into early workflow stages, delegating to non-physician staff, and optimizing the electronic health record.

Conclusions:

Clinicians recognized the PHQ-9’s value for patients with MS; however, its routine use in ARMC’s neurology clinic is limited by workflow constraints, lack of training, and patient-related complexities. Successful implementation requires integration into workflow processes and electronic health records, clear team roles, and targeted education to improve familiarity with the tool. These changes may enhance feasibility without adding burden, enabling consistent identification of depressive symptoms and patient-centered care in this high-risk population.