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Major depressive disorder (MDD) is an important illness to assess periodically using a validated instrument, however, the four-month measurement period is not based on clinical evidence. Based on the depression or dysthymia severity, a longer measurement period may be needed. There are other validated tools to measure MDD that should be included in this performance measure. The type of patient should also be taken into consideration (pregnant, post-partum, geriatric, etc.). The performance measure specifications are unclear as to whether the PHQ-9 should be administered every four months for on-going depression evaluation or just once within a four-month time period. The developer should consider revising the denominator to clarify the appropriate time interval. The PHQ-9 score may be simple to catalog if the facility has an electronic health record (EHR).