Patient Health Questionnaire-9 (PHQ-9)

Scoring

Response	Points
Not at all	0
Several days	1
More than half the days	2
Nearly every day	3

Add the points for questions 1 to 9. The total ranges from 0 to 27. Question 10 is not scored.

Interpretation

Score	Severity	Usual next step
0–4	Minimal	None needed beyond routine monitoring.
5–9	Mild	Watchful waiting; repeat PHQ-9 at follow-up.
10–14	Moderate	Consider counselling, psychotherapy, or medication; create a treatment plan.
15–19	Moderately severe	Active treatment with psychotherapy and/or medication.
20–27	Severe	Prompt referral for psychiatric evaluation and treatment.

About the PHQ-9

The Patient Health Questionnaire-9 (PHQ-9) is a self-administered questionnaire developed by Drs. Robert Kroenke, Robert Spitzer, and Janet Williams and published in 2001. Its nine items map directly onto the nine diagnostic criteria for major depressive disorder, which is why clinicians trust it both for initial screening and for tracking whether treatment is working over time.

Each question asks how often you have been bothered by a symptom over the last two weeks. Answers are scored from 0 ("Not at all") to 3 ("Nearly every day"), giving a total between 0 and 27. Higher scores indicate more severe depressive symptoms. In the original validation study, a score of 10 or higher identified major depression with sensitivity and specificity of about 88 percent, which is why 10 is the most widely used threshold for further clinical evaluation.

The tenth question, on how difficult the problems have made daily life, is not added to the score. It gives the clinician context: two people can have the same symptom score but very different levels of functional impairment, and that difference matters for treatment decisions.

Understanding your score in detail

0 to 4 (minimal). Few or no depressive symptoms. No specific treatment is indicated. If the questionnaire was taken because of a concern, it is still worth repeating it in a few weeks, since mood can change.

5 to 9 (mild). Mild symptoms that may reflect temporary stress or the early phase of depression. The usual approach is watchful waiting: repeat the PHQ-9 at the next visit, discuss sleep, exercise, and stress, and consider counselling if symptoms persist or worsen.

10 to 14 (moderate). This is the range where clinical depression becomes likely and treatment is usually discussed. Options include psychotherapy (such as cognitive behavioural therapy), antidepressant medication, or both, chosen together with the patient based on preference, history, and severity.

15 to 19 (moderately severe). Active treatment is warranted in this range. Most guidelines recommend combining psychotherapy with medication, with close follow-up to check response within a few weeks.

20 to 27 (severe). Severe symptoms that need prompt professional evaluation. Referral to psychiatry or a mental health specialist is recommended, and safety planning is essential, particularly if question 9 is positive.

A useful clinical rule is the concept of response and remission during treatment: a drop of at least 5 points is generally considered a meaningful response, and a score below 5 is often used as the definition of remission. Repeating the PHQ-9 every few weeks during treatment gives both patient and clinician an objective measure of progress.

PHQ-9 versus PHQ-2

The PHQ-2 is an ultra-brief version consisting of only the first two PHQ-9 items (loss of interest and feeling down), scored from 0 to 6. It is designed for rapid screening in busy clinics: a score of 3 or higher suggests the full PHQ-9 should be administered. The PHQ-2 is a screening gate, not a severity measure; only the full PHQ-9 grades severity and tracks change over time.

Who should use the PHQ-9

The PHQ-9 was designed for adults in primary care, and that remains its main setting. It is used to screen people with risk factors or vague complaints (fatigue, sleep problems, chronic pain), to establish a baseline before starting treatment, and to monitor response at follow-up visits. An adapted version, the PHQ-A, exists for adolescents. The questionnaire is also widely used in research as a standardised outcome measure.

It is not a self-diagnosis tool. A score can suggest that depression is likely and guide the conversation with a clinician, but the diagnosis of a depressive disorder requires a clinical interview that considers medical causes, substance use, bereavement, and other psychiatric conditions.

Limitations to keep in mind

• A screening score is not a diagnosis. Medical conditions such as hypothyroidism, anaemia, and sleep apnoea can produce identical symptoms and must be ruled out.
• Cultural background influences how distress is expressed; somatic complaints may dominate in some populations, which can shift scores.
• The questionnaire covers the previous two weeks only, so it can miss longer-term patterns or rapid recent changes.
• Question 9 on self-harm must never be ignored, even when the total score is low. Any positive answer needs an immediate, direct conversation about safety.

Frequently asked questions

How often should the PHQ-9 be repeated?

In treatment, every 2 to 4 weeks is typical until remission, then less often for maintenance. For general screening, repeating it at routine check-ups or when symptoms change is reasonable.

Does a high score mean I have depression?

No. A high score means depressive symptoms are present and significant, and that a clinical evaluation is warranted. Only a qualified clinician can make the diagnosis after ruling out medical and other psychiatric causes.

What is a clinically meaningful change in score?

A drop of 5 or more points is generally regarded as a meaningful treatment response, and a score below 5 is commonly used to define remission. Smaller changes may reflect normal week-to-week variation.

Why is question 10 not scored?

Question 10 measures functional impairment: how much the symptoms interfere with work, home life, and relationships. It is deliberately kept separate because symptom severity and life impact do not always move together, and treatment decisions consider both.

Can teenagers take the PHQ-9?

The standard PHQ-9 was validated in adults. For adolescents aged 12 to 17, the PHQ-A (adolescent version) is the adapted instrument clinicians prefer.

What should I do if question 9 is positive?

Take it seriously regardless of the total score. Speak to a clinician promptly, and if you feel you may act on these thoughts, contact your local emergency number or a crisis helpline immediately.