What do PHQ-9 scores mean?

Scores of 0–4 indicate minimal depression, 5–9 mild, 10–14 moderate, 15–19 moderately severe, and 20–27 severe depression. A score of 10 or above is the commonly used threshold for clinical significance and typically warrants evaluation and possible treatment.

The PHQ-9 (Patient Health Questionnaire-9) is a validated screening tool for depression developed by Drs. Spitzer, Williams, and Kroenke in 1999. It consists of 9 items corresponding to DSM criteria for major depressive disorder, each rated 0–3 based on symptom frequency over the past 2 weeks.

Can the PHQ-9 diagnose depression?

No. The PHQ-9 is a screening tool, not a diagnostic instrument. A high score indicates likely depression and the need for clinical evaluation, but formal diagnosis requires a comprehensive assessment by a qualified clinician, including a clinical interview, duration assessment, and exclusion of other causes.

How accurate is the PHQ-9?

At a cutoff of 10, the PHQ-9 has a sensitivity of approximately 88% and specificity of 85% for major depression. This means it correctly identifies most people with depression but also produces some false positives. It performs comparably to clinician-administered instruments.

How often should I take the PHQ-9?

For general screening: annually or when symptoms arise. For treatment monitoring: every 2–4 weeks after starting or changing antidepressant therapy. The PHQ-9 is designed to be repeatable, and tracking scores over time is one of its primary clinical uses.

What is a clinically significant change in PHQ-9?

A change of 5 or more points is generally considered clinically meaningful. A 50% reduction from baseline is often used to define 'treatment response,' and a final score below 5 is often used to define 'remission.'

Who developed the PHQ-9?

The PHQ-9 was developed by Drs. Robert Spitzer, Janet Williams, and Kurt Kroenke with an educational grant from Pfizer. It was first published in 2001 and is now in the public domain, available for use without permission or licensing fees.

Is the PHQ-9 free to use?

Yes. The PHQ-9 is in the public domain and can be used without permission or cost. It is freely available from multiple sources including the original validation papers, medical organization websites, and tools like this one.

What's the difference between PHQ-9 and PHQ-2?

The PHQ-2 uses only the first 2 questions (depressed mood and anhedonia) as a rapid screening tool. A score of 3+ on PHQ-2 has good sensitivity for depression and is often used as a first step, followed by the full PHQ-9 if positive.

Can I use PHQ-9 for anxiety?

No. The PHQ-9 is specific to depression. For anxiety screening, use the GAD-7 (Generalized Anxiety Disorder-7). Depression and anxiety often co-occur, so administering both PHQ-9 and GAD-7 together is common practice.

Is PHQ-9 valid for older adults?

The PHQ-9 is validated in older adults but may perform less well in those with cognitive impairment or dementia. The Geriatric Depression Scale (GDS) is an alternative specifically designed for elderly populations.

What should I do if I score 20 or higher?

A score of 20–27 indicates severe depression. You should seek evaluation from a healthcare provider as soon as possible. Severe depression often benefits from medication, psychotherapy, or both. If you have thoughts of suicide, contact a crisis line or go to an emergency room.

Does the PHQ-9 work in different languages?

Yes. The PHQ-9 has been translated and validated in over 80 languages. Validated translations maintain the psychometric properties of the original English version. Ensure you use an officially validated translation rather than an informal one.

How does PHQ-9 relate to DSM-5 criteria?

The 9 PHQ-9 items correspond directly to the 9 DSM-5 symptom criteria for major depressive disorder. However, the PHQ-9 does not assess duration (2+ weeks required), functional impairment, or exclusion criteria — these require clinical evaluation for formal diagnosis.

Online Medical Tools — PHQ-9

Printed on 8/14/2026

For informational purposes only. This is not medical advice.

Mental Health

PHQ-9

The Patient Health Questionnaire-9 (PHQ-9) is the gold standard screening tool for depression, used by clinicians worldwide. Answer 9 questions about symptoms over the past 2 weeks to receive your severity score (0–27) with clinical interpretation. The PHQ-9 is recommended by the USPSTF for routine depression screening in adults. For rapid 2-question screening, use PHQ-2. For comorbid anxiety assessment, see GAD-7. Alcohol use often co-occurs with depression — screen with AUDIT. Depression is associated with poor metabolic health — track physical wellness with BMI Calculator.

Formula: Total score = sum of all 9 items (each 0-3). Range 0-27.

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

9. Thoughts that you would be better off dead, or of hurting yourself in some way

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How It Works

Answer 9 questions

Rate how often you've experienced each symptom over the past 2 weeks: not at all (0), several days (1), more than half the days (2), or nearly every day (3).

Get your severity score

Your responses are summed to produce a score from 0–27. The score maps to five severity categories: minimal, mild, moderate, moderately severe, or severe depression.

Understand your results

Review what your score means and recommended next steps. Scores of 10+ suggest clinical evaluation is warranted. Any positive response to question 9 requires attention.

Who Uses the PHQ-9

Primary Care Screening

Family physicians & internists

The USPSTF recommends depression screening for all adults. PHQ-9 is the most widely used tool, taking under 3 minutes and providing actionable severity stratification.

Treatment Monitoring

Psychiatrists & therapists

Serial PHQ-9 scores every 2–4 weeks track treatment response objectively. A 5-point change is clinically meaningful; 50% reduction indicates treatment response.

Clinical Research

Researchers

PHQ-9 is a primary outcome measure in depression trials. Its standardization and validation enable comparison across studies and meta-analyses.

Workplace Wellness

Employee assistance programs

EAPs use PHQ-9 to identify employees who may benefit from mental health resources. Early screening reduces long-term disability and improves productivity.

College Health

University counseling centers

Depression is common among college students. PHQ-9 helps counseling centers triage students efficiently and track outcomes across the academic year.

Personal Check-In

Individuals self-monitoring

If you're wondering whether what you're feeling might be depression, PHQ-9 provides an evidence-based starting point for self-reflection before seeking professional help.

Pro Tips

Answer based on the past 2 weeks

The PHQ-9 asks about the last 2 weeks specifically. Don't include symptoms from months ago or worry about how you usually feel — focus on the recent period.

Be honest, not aspirational

Answer how things actually are, not how you wish they were or how you think you should feel. The tool is only useful if you're truthful with yourself.

Question 9 matters regardless of score

Any positive response to question 9 (thoughts of death or self-harm) warrants attention and a conversation with a professional, even if your total score is low.

A score of 10 is the clinical threshold

While any score can prompt further evaluation, 10+ is the widely used cutoff for 'clinically significant' depression that may benefit from treatment.

Track changes over time

Taking the PHQ-9 periodically (monthly or after treatment changes) lets you see trends. A 5-point improvement is clinically meaningful; 50% reduction indicates response.

This is screening, not diagnosis

A high PHQ-9 score suggests you may have depression, but diagnosis requires a clinical interview. Use this as a starting point for a conversation with a provider.

Consider taking GAD-7 too

Depression and anxiety often co-occur. If you score elevated on PHQ-9, the GAD-7 anxiety screen can provide additional useful information for your provider.

Medical conditions can inflate scores

Fatigue, sleep problems, and appetite changes also occur in many medical conditions (thyroid disorders, anemia, chronic pain). Consider whether physical health factors may be contributing.

Share your score with your doctor

Bringing a completed PHQ-9 to your appointment saves time and gives your provider objective data. It also makes it easier to discuss sensitive symptoms you might otherwise not mention.

Low score doesn't mean you're fine

If you're struggling but scored low, trust your experience. The PHQ-9 captures common depression symptoms but may miss atypical presentations. Seek help if you need it.

Common Questions About Your Results

Evidence-Based Methodology

The PHQ-9 was developed and validated by Drs. Spitzer, Williams, and Kroenke (2001). At a cutoff of 10, sensitivity is 88% and specificity is 85% for major depression. The USPSTF recommends depression screening for all adults, and PHQ-9 is one of the most widely used instruments globally, with over 10,000 citations.

Clinical Content Trust

Last reviewed:: April 21, 2026
Guideline version:: General evidence framework v2026.04
Source set version:: Primary-source set v1

How to Interpret Your Result

Your PHQ-9 score falls into one of five severity categories: minimal (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), or severe (20–27). A score of 10 or higher is commonly used as the clinical threshold that warrants further evaluation and possible treatment.

Beyond the total score, pay attention to question 9 (thoughts of self-harm or death). Any positive response to this item — even "several days" — should prompt a direct conversation with a healthcare provider about safety, regardless of the overall score. The PHQ-9 is also useful for tracking changes over time; a decrease of 5 or more points generally indicates clinically meaningful improvement.

When to Use This Tool

The PHQ-9 is appropriate for initial depression screening in primary care, behavioral health, and community settings. The U.S. Preventive Services Task Force (USPSTF) recommends depression screening for all adults, and the PHQ-9 is one of the most widely used instruments for this purpose.

It is also valuable for monitoring treatment response — repeating the PHQ-9 every 2–4 weeks after starting or adjusting antidepressant therapy provides an objective measure of whether the patient is improving. Many clinical practices and research trials use serial PHQ-9 scores as a primary outcome measure.

Limitations

The PHQ-9 is a screening tool, not a diagnostic instrument. A high score does not confirm a diagnosis of major depressive disorder — formal diagnosis requires a clinical interview assessing DSM criteria, duration, functional impairment, and exclusion of other causes (e.g., hypothyroidism, substance use, grief).

The questionnaire relies on self-report over the past two weeks, which introduces recall bias. Patients may minimize or exaggerate symptoms depending on their comfort level, cultural background, or the setting. Somatic symptoms of depression (fatigue, appetite changes, sleep problems) overlap with many medical conditions, which can inflate scores in medically ill patients.

The PHQ-9 has been validated across many populations but performs less reliably in certain groups, including adolescents (for whom the PHQ-A is preferred), older adults with cognitive impairment, and patients with limited health literacy.

Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.

Changelog

April 21, 2026 · trust-baseline
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