The PHQ-9 is a 9-item questionnaire that scores depressive symptoms over the past two weeks on a 0–27 scale. Standard bands are minimal (0-4), mild (5–9), moderate (10-14), moderately severe (15–19), and severe (20–27). Any score above 0 on item 9 (self-harm or death thoughts) needs prompt suicide risk assessment, even if the total is low. Use the free PHQ-9 calculator to total items and map the band, then interpret the result with clinical judgment.
Definitions
| Term | Meaning |
|---|---|
| PHQ-9 | Patient Health Questionnaire-9: nine symptom items scored 0–3 each; total 0–27 |
| Severity band | Category for the total score (minimal through severe) used to guide intensity of care |
| Item 9 | Question on thoughts of death or self-harm; any positive response triggers risk assessment |
| Item 10 | Optional functional-impairment question; not added to the 0–27 total |
| Screening vs diagnosis | PHQ-9 flags and grades symptoms; diagnosis still requires a full clinical assessment |
What does the PHQ-9 measure?
The PHQ-9 covers nine symptom domains over the past two weeks: little interest or pleasure, low mood, sleep change, fatigue, appetite change, guilt or worthlessness, concentration problems, psychomotor change, and thoughts of death or self-harm.
Each response scores 0 (not at all), 1 (several days), 2 (more than half the days), or 3 (nearly every day). Add the nine scores for a total from 0 to 27. Item 10 asks how hard these problems make work, home life, or relationships; it informs function but is not counted in the total.
Clinically the tool supports screening, severity grading, and monitoring after treatment starts. It is a structured symptom inventory, not a full psychiatric interview. A high score raises concern; a low score does not exclude every form of distress.
Kroenke and colleagues validated the PHQ-9 as a brief depression severity measure (Journal of General Internal Medicine, 2001). Those cutoffs remain the bands most teams use in primary care.
What do PHQ-9 scoring bands mean?
| Score | Category | Typical clinical stance |
|---|---|---|
| 0-4 | Minimal | Monitoring and support may suffice |
| 5–9 | Mild | Watchful waiting, lifestyle support, follow-up |
| 10–14 | Moderate | Consider therapy and/or medication planning |
| 15–19 | Moderately severe | Active treatment usually recommended |
| 20–27 | Severe | Urgent psychiatric evaluation and treatment |
Bands are guides, not automatic diagnoses. Two people with the same total can look different, so read the item pattern, not only the sum. When tracking response, repeat the tool under similar conditions and look for a clear drop in score or a move into a lower band. Local protocols override any single teaching rule of thumb.
Calculate and map bands with the PHQ-9 depression test on AchaWaqat, then place the number next to history and exam findings.
When should you escalate after a PHQ-9?
Escalation follows risk, severity, function, and trajectory, not the total alone.
Item 9 comes first
Item 9 asks about thoughts of being better off dead or of hurting yourself. Any score greater than 0 on item 9 requires prompt suicide risk assessment, even if the total is low. Ask about plan, intent, means, protective factors, and need for emergency care. If immediate danger exists, use local emergency pathways without delay.
Escalate for severity and impairment
Consider faster or higher-intensity care when:
- Total is moderately severe (15–19) or severe (20–27)
- Function at work, school, or home is markedly impaired (item 10 can flag this)
- Symptoms worsen despite current support
- Psychosis, mania concern, severe agitation, or inability to meet basic needs is present
- The person cannot safely wait for a routine appointment
For moderate scores (10–14), many pathways still recommend a structured treatment plan: evidence-based psychotherapy, medication discussion when appropriate, closer follow-up, or mental health referral rather than indefinite watchful waiting.
Escalate when context does not fit a simple score
Also escalate or refer when bipolar spectrum illness is possible, when substance use or medical illness may drive symptoms, in pregnancy or postpartum (consider period-specific tools alongside), or when trauma- or anxiety-primary presentations need parallel assessment. Pair depression screening with the GAD-7 anxiety test when needed, and browse Mental Health Calculators.
What are the limitations of the PHQ-9?
It is not a standalone diagnosis. Duration, impairment, differential diagnosis, and other causes still need clinical judgment.
Item 9 is a screen, not a full risk assessment. Zero does not guarantee safety; a positive response does not define intent or immediacy by itself.
Context can shift scores. Medical illness, grief, sleep problems, medication effects, language, literacy, and cultural expression of distress can raise or lower totals.
Cutoffs are population averages. Primary-care thresholds may need local judgment in specialty clinics, older adults, adolescents, or cross-cultural settings.
Serial scores need consistent conditions. Changing language or administration method weakens comparisons. Comorbidity (anxiety, PTSD, ADHD, substance use) is common, so one screen rarely tells the whole story.
How should you use a PHQ-9 score in a clinic visit?
- Complete or review the PHQ-9 calculator.
- Check item 9 first, then the total and band.
- Ask about functional impact (item 10 and the patient’s own words).
- Place the score in context: history, exam, meds, substances, safety.
- Agree a plan and schedule follow-up; repeat the PHQ-9 to track change.
Document the total, item 9, risk assessment, and shared plan so later scores remain meaningful.
FAQ
What is a normal PHQ-9 score?
Scores of 0–4 usually fall in the minimal band and often need only monitoring if function is preserved and item 9 is zero. “Normal” is not the same as “no distress”; context still matters.
Is a PHQ-9 of 10 depression?
A total of 10 starts the moderate band and commonly prompts a treatment plan discussion. It supports concern for clinically important symptoms but is not, by itself, a formal diagnosis.
Does item 9 matter if the total score is low?
Yes. Any response greater than 0 on item 9 warrants prompt suicide risk assessment regardless of the total.
Can I diagnose depression with the PHQ-9 alone?
No. The PHQ-9 is a screening, severity, and monitoring aid. Diagnosis still needs clinical assessment of criteria, duration, impairment, and differential diagnosis.
How often should the PHQ-9 be repeated?
Many clinics repeat it at follow-up visits during active treatment, often every few weeks. Match the interval to your local pathway and to how fast the picture is changing.
Medical disclaimer
This article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. The PHQ-9 is a clinical screening and monitoring tool; results must be interpreted by a qualified healthcare professional in the context of a full clinical assessment. If you or someone else is in crisis or having thoughts of self-harm, seek emergency help immediately through local emergency services or a crisis hotline. Do not delay care based on an online score alone.
Suggested internal link anchors
- PHQ-9 calculator → https://achawaqat.com/calculators/mental-health/phq-9-depression-test
- Mental health calculators → https://achawaqat.com/calculators/mental-health/
- GAD-7 anxiety scale → https://achawaqat.com/calculators/mental-health/gad-7-anxiety-test