PHQ-15 (Patient Health Questionnaire-15): Take It, Score It, Understand Your Results

The PHQ-15 (Patient Health Questionnaire-15) is a brief self-report screen for somatic (physical) symptom burden. It was developed by Drs. Kroenke, Spitzer, and Williams and validated in 2002 in roughly 6,000 primary care and obstetrics-gynecology patients. The PHQ-15 has 15 items rated 0-1-2 for a total score range of 0-30, with severity bands of 5 (low), 10 (medium), and 15 (high). It is NOT a depression scale — that is the PHQ-9, a different 9-item instrument in the same PHQ family. The PHQ-15 is widely used in primary care, where up to half of visits involve physical symptoms without a clear medical explanation. It is a screening tool for symptom monitoring, not a diagnosis of somatic symptom disorder (which requires DSM-5 psychological criteria the PHQ-15 does not measure).

How to interpret your PHQ-15 score: the 5 / 10 / 15 cutoffs

Your PHQ-15 total score runs from 0 to 30. Each of the 15 items is rated 0 (“not bothered at all”), 1 (“bothered a little”), or 2 (“bothered a lot”), and the answers are summed. The interpretation bands come from the original 2002 validation in roughly 6,000 primary care and obstetrics-gynecology patients by Kroenke, Spitzer, and Williams. A 2025 JAMA Network Open meta-analysis of 305 studies and 361,243 participants confirms these cutoffs are still the field standard for 2026.

PHQ-15 score of 15 is not a PHQ-9 score of 15

This is the single most common point of confusion. The PHQ-15 measures physical (somatic) symptom burden. A PHQ-15 score of 15 sits at the bottom of the “high severity” band on the somatic symptom scale. The PHQ-9 measures depression on a different 9-item instrument with its own score range, and a “PHQ-9 score of 15” is a depression result, not a PHQ-15 result. Kroenke’s 2002 validation explicitly showed that “somatic and depressive symptom severity had differential effects on outcomes,” which is the empirical reason the two scales are kept separate.

A high PHQ-15 score is best read as a flag for a conversation about your physical symptoms — not as a label for any specific condition.

The four PHQ-15 symptom domains: cardiopulmonary, fatigue, gastrointestinal, and pain

The 2025 JAMA Network Open meta-analysis found that PHQ-15 items cluster into four clinically meaningful domains plus a general somatic burden factor. The general factor accounted for 19-45% of variance across studies, with the rest carried by the four domain factors. Two people with the same total score can therefore have very different symptom profiles.

The 15 items are paraphrased below by domain. For the verbatim wording of each item, consult the official PHQ Screeners site at phqscreeners.com, the developers’ public-domain home for the PHQ family.

• Cardiopulmonary domain. Chest pain, heart pounding or racing (palpitations), shortness of breath, dizziness, and fainting spells.
• Fatigue domain. Feeling tired or having low energy, and trouble sleeping. These two items were added when the somatoform module evolved from the original 13-item Patient Health Questionnaire (PHQ) into the modern PHQ-15.
• Gastrointestinal domain. Stomach pain, nausea or gas or indigestion, and constipation or loose bowels or diarrhea.
• Pain domain. Back pain, pain in arms or legs or joints, and headaches.

Two further items sit outside the four-domain structure: menstrual cramps or other problems with periods (asked of women), and pain or other problems during sexual intercourse. In the meta-analysis, both showed lower item-total correlations (below 0.40), alongside fainting spells. They still contribute to the total score, but they behave less like the rest of the scale.

The pooled internal consistency for the full 15 items across 305 studies was Cronbach α = 0.81 (95% CI 0.80-0.82), which is adequate for a self-report screen. Older single-study figures (α = .80, sensitivity 78%, specificity 71%, AUC .76 for a DSM-IV somatoform disorder) corroborate the newer pooled estimate.

The PHQ-15 is a screening tool, not a diagnosis.

A high PHQ-15 is NOT a diagnosis of somatic symptom disorder

This is the load-bearing distinction. A high PHQ-15 score tells you that physical symptoms have been bothering you a lot. It does not tell you that you have somatic symptom disorder (SSD). These two ideas get conflated all the time, partly because the PHQ-15 was originally designed to help identify somatoform presentations in primary care.

What DSM-5 actually requires for SSD

According to the Merck Manual Professional, somatic symptom disorder is “characterized by disproportionate and excessive thoughts, feelings, and concerns about physical symptoms”. The DSM-5 criteria require physical symptoms that have been distressing or disruptive for more than six months, combined with at least one of the following:

• “Disproportionate and persistent thoughts about the seriousness of the symptoms”
• “Persistently high anxiety about health or the symptoms”
• “Excessive time and energy spent on the symptoms or health concerns”

NCBI StatPearls echoes the same DSM-5 framing — physical symptoms causing significant distress, plus persistent excessive thoughts or behaviors lasting beyond six months. The PHQ-15 measures only the physical-symptom burden part. It does not ask about disproportionate thoughts, persistent anxiety, or how much time and energy a person is spending on health concerns.

Why the AUC matters here

The JAMA 2025 meta found that PHQ-15 diagnostic accuracy for somatoform disorders had area under the ROC curve of 0.63 to 0.79 — which the meta-analysts described as “only borderline acceptable” screening ability. That is the empirical basis for treating the PHQ-15 as severity monitoring rather than a diagnostic test.

For context, SSD itself is not rare. NCBI StatPearls reports SSD prevalence of approximately 5-7% of the general population, rising to roughly 17% in primary care settings, with a 10:1 female-to-male ratio. Approximately 90% of cases persist beyond five years. One counter-intuitive evidence point from the same source: extensive diagnostic testing does not reduce SSD symptoms. That is the case for a coordinated care relationship — not a reason to stop seeking care.

PHQ-15 vs PHQ-9 vs GAD-7 vs PHQ-SADS: which questionnaire measures what

The PHQ family was developed at Pfizer in the mid-1990s as a self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Each member of the family covers a different construct. Knowing which scale measures what is the cleanest way to interpret a result you’ve already received — or to pick the right next screen if a PHQ-15 leaves a question open.

Each instrument is public domain; no fees or permissions are required for use. The PHQ family has been validated internationally and is available in over 20 languages.

A common pairing pattern: a person taking a PHQ-15 might also benefit from the PHQ-9 if low mood is part of the picture, or the GAD-7 if worry and anxiety are prominent. The JAMA 2025 meta found moderate correlations between the PHQ-15 and depression (r = 0.62) and anxiety (r = 0.54) measures. That fits the clinical observation that somatic, depressive, and anxious symptoms often travel together but remain distinct enough to merit separate screens.

A note on the AAFP heuristic: family medicine literature has long used a quick “bothered a lot by at least 3 of the items” rule as a clinician-friendly screen. That heuristic references the 13-item PHQ somatoform precursor — not the modern 15-item version, which added fatigue and trouble sleeping. It complements the Kroenke 5/10/15 cutoffs rather than replacing them.

What a meaningful change in your PHQ-15 score looks like over time

If you’re using the PHQ-15 to track whether something is changing — therapy, lifestyle adjustments, a new chronic-condition management plan — the meta-analytic minimal clinically important difference (MCID) is 3 points. A change smaller than 3 points often falls within the range of normal variation rather than reflecting a real shift in symptom burden.

In patient language: a drop from 12 to 9 is the smallest change that typically signals something is genuinely shifting, not measurement noise. A drop from 12 to 11 is more likely to be noise.

Two caveats are worth knowing:

• The MCID evidence base is moderate, not definitive. The JAMA meta noted that sensitivity-to-change evidence is limited, and cognitive-behavioral therapy versus controls showed a moderate effect size of g = 0.32.
• Test-retest reliability over short intervals varies. The meta found r = 0.65 to 0.93 for retests over 10 to 14 days.

Trends across several months matter more than week-to-week numbers. The PHQ-15 remains a severity-monitoring screening tool, not a diagnostic test.

Frequently asked questions

Where can I get the official PHQ-15 PDF?

The PHQ-15 is public domain and is hosted by the instrument’s developers (Drs. Spitzer, Williams, and Kroenke, with Pfizer support) at phqscreeners.com. No fees or permissions are required for personal or clinical use, and the instrument is available in over 20 languages.

Is the PHQ-15 the same as a PHQ-9 score of 15?

No. The PHQ-15 is a 15-item somatic symptom severity scale. The PHQ-9 is a 9-item depression scale with different items and a different score range. The two scales share the PHQ name family but measure different constructs.

Does a high PHQ-15 mean I have somatic symptom disorder?

No. A high PHQ-15 reflects physical symptom burden, not a DSM-5 diagnosis. Somatic symptom disorder additionally requires distressing physical symptoms for more than six months plus at least one of: disproportionate thoughts, persistently high anxiety, or excessive time and energy spent on health concerns. The PHQ-15 does not measure those psychological criteria.

Is somatic symptom disorder the same as hypochondria?

The two terms are not interchangeable. Somatic symptom disorder describes distressing physical symptoms accompanied by disproportionate thoughts, persistent anxiety, or excessive time and energy spent on the symptoms — for more than six months. The PHQ-15 measures the physical-symptom-burden part of that picture, which is why it sits closer to SSD than to other health-anxiety diagnoses.

How is the PHQ-15 administered?

It is a brief, self-administered questionnaire with 15 items, each rated on a 0-1-2 scale. Kroenke’s authors characterize it as “a brief, self-administered questionnaire that may be useful in screening for somatization and in monitoring somatic symptom severity in clinical practice and research”.

Is the PHQ-15 covered by insurance?

The instrument itself is free and public-domain, so there is nothing to bill for the tool. A clinical visit that includes administering and reviewing the PHQ-15 is billed under the visit’s own codes; coverage varies by plan.

Can children take the PHQ-15?

The original Kroenke 2002 validation studied adults in primary care and obstetrics-gynecology settings. For younger ages, a clinician will typically choose age-appropriate tools.

When to talk to your doctor — and when to call 988 or 911

The PHQ-15 does not assess suicide risk. It has no item analogous to PHQ-9 item 9, which specifically asks about thoughts of self-harm. A person experiencing physical symptoms alongside thoughts of suicide or self-harm needs immediate crisis-line contact regardless of any PHQ-15 score.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

For non-crisis situations, consider scheduling a primary-care or specialty visit if any of the following applies:

• Your PHQ-15 score is 10 or higher, indicating medium-to-high somatic symptom burden
• Your PHQ-15 score is 5-9 but your symptoms are interfering with daily functioning — the Kroenke validation linked rising scores to declining functional status across multiple domains
• Your physical symptoms have lasted more than a few weeks without clear medical explanation. AAFP notes that up to 50% of primary-care patients present with physical symptoms that cannot be explained by a general medical condition
• You are noticing high anxiety, low mood, or sleep problems alongside the physical symptoms. The JAMA meta found moderate correlations between PHQ-15 and depression (r = 0.62) and anxiety (r = 0.54), so a clinician may add the PHQ-9 or GAD-7 to round out the picture
• You have already been told your PHQ-15 is high and are now considering more tests — NCBI StatPearls notes that extensive diagnostic testing does not, on average, reduce somatic symptom burden

Some symptoms always warrant in-person evaluation regardless of any questionnaire score: new chest pain with shortness of breath, sudden severe headache, focal neurological changes (one-sided weakness, slurred speech, vision loss), unexplained weight loss, or unexplained bleeding. AAFP frames the principle plainly: the challenge in primary care is to “simultaneously exclude medical causes for physical symptoms while considering a mental health diagnosis”. The PHQ-15 helps with the second half of that sentence; it does not replace the first.

A high PHQ-15 score is a reason to talk to a clinician, not a reason to draw a conclusion on your own. The PHQ-15 is a screening tool, not a diagnosis.

Last reviewed: 2026-05-19