PHQ-9
Patient Health Questionnaire-9
The most widely used self-report measure of depression severity.
9
3 min
adult
0–27
About the PHQ-9
The Patient Health Questionnaire-9 (PHQ-9) is a brief, nine-item self-report instrument that measures the severity of depression. Each item maps directly onto one of the nine DSM criteria for major depressive disorder, so the questionnaire doubles as both a screening tool and a severity measure that can be repeated to track change over time.
Developed by Spitzer, Kroenke and Williams as part of the PRIME-MD diagnostic instrument, the PHQ-9 asks respondents how often they have been bothered by each symptom over the previous two weeks, from "not at all" (0) to "nearly every day" (3). The total score ranges from 0 to 27, with established cut-points dividing scores into minimal, mild, moderate, moderately severe, and severe depression.
Because it is in the public domain, validated across hundreds of populations, and quick to complete, the PHQ-9 has become the default depression measure in primary care, mental-health, and routine outcome-monitoring settings worldwide.
What it measures
- Depressed mood and loss of interest or pleasure (the two cardinal symptoms of depression)
- Neurovegetative symptoms: sleep disturbance, appetite change, fatigue, psychomotor change
- Cognitive symptoms: poor concentration and feelings of worthlessness or guilt
- Item 9 screens directly for thoughts of being better off dead or self-harm, flagging suicide risk
PHQ-9 questions
- 1
Little interest or pleasure in doing things
- 2
Feeling down, depressed, or hopeless
- 3
Trouble falling or staying asleep, or sleeping too much
- 4
Feeling tired or having little energy
- 5
Poor appetite or overeating
- 6
Feeling bad about yourself — or that you are a failure or have let yourself or your family down
- 7
Trouble concentrating on things, such as reading the newspaper or watching television
- 8
Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
- 9
Thoughts that you would be better off dead or of hurting yourself in some way
Risk item
Items reproduced from a documented, freely usable source. Item wording is preserved exactly as published.
Scoring & interpretation
The PHQ-9 takes most respondents two to three minutes to complete and can be self-administered or read aloud. Each of the nine items is scored 0–3 and summed for a total of 0–27.
Standard severity cut-points are 5 (mild), 10 (moderate), 15 (moderately severe), and 20 (severe). A score of 10 or above is the most commonly used threshold for probable major depression. A positive response to item 9 should always prompt direct assessment of suicide risk, regardless of the total score.
| Range | Band | Interpretation |
|---|---|---|
| 0–4 | Minimal | Minimal or none |
| 5–9 | Mild | Mild depression — watchful waiting; repeat at follow-up. |
| 10–14 | Moderate | Moderate depression — treatment plan, counselling, follow-up and/or pharmacotherapy. |
| 15–19 | Moderately severe | Moderately severe depression — active treatment with pharmacotherapy and/or psychotherapy. |
| 20–27 | Severe | Severe depression — immediate initiation of pharmacotherapy and, if severe impairment or poor response, expedited referral to a mental health specialist. |
Higher scores indicate greater symptom severity.
Clinical applications
- Screening for major depressive disorder in primary care and mental-health intake
- Measuring baseline severity and tracking treatment response in measurement-based care
- Stepped-care and collaborative-care pathways where scores trigger treatment decisions
- Population health and quality reporting where a standardised depression metric is required
Validation & psychometrics
In the original validation study (Kroenke, Spitzer & Williams, 2001), a PHQ-9 score of 10 or greater had a sensitivity of 88% and a specificity of 88% for major depression. The measure shows excellent internal consistency and good test–retest reliability, and its scores correlate strongly with independent clinician ratings and functional-status measures.
Strengths & considerations
- A high score is not a diagnosis — confirm with clinical interview before treatment decisions.
- Somatic items (sleep, appetite, fatigue, concentration) can be elevated by physical illness; interpret in context.
- Always follow up any endorsement of item 9 with a structured suicide-risk assessment.
Frequently asked questions
What is a normal PHQ-9 score?
Scores of 0–4 indicate minimal or no depression. Scores of 5–9 suggest mild symptoms, 10–14 moderate, 15–19 moderately severe, and 20–27 severe depression.
What PHQ-9 score indicates depression?
A total score of 10 or higher is the most widely used threshold for probable major depressive disorder, with roughly 88% sensitivity and specificity in the validation study.
Is the PHQ-9 free to use?
Yes. The PHQ-9 is in the public domain. It may be used, reproduced, and translated without permission or licensing fees.
How often can the PHQ-9 be repeated?
Because each administration covers the previous two weeks, it is commonly repeated every two to four weeks to monitor treatment response.
Source & references
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