PHQ-9 Depression Screening: Take It, Score It, Understand Your Results
The PHQ-9 (Patient Health Questionnaire-9) is a brief 9-item self-report questionnaire used to screen for symptoms of depression over the past two weeks. Developed in 2001 by Spitzer, Kroenke, and Williams under a research grant from Pfizer, it is one of the most widely used depression screeners in primary care worldwide. The PHQ-9 takes about 5 minutes to complete, is offered free of charge as a public-domain instrument, and produces a single 0-27 severity score that helps a clinician decide whether further evaluation is warranted. The PHQ-9 is a screening tool, not a diagnosis: results should always be reviewed with a healthcare professional rather than used to self-diagnose.
What is the PHQ-9?
The PHQ-9 (Patient Health Questionnaire-9) is a brief depression screening questionnaire developed in 2001 by Drs. Robert Spitzer, Kurt Kroenke, and Janet Williams as the depression module of the larger PRIME-MD (Primary Care Evaluation of Mental Disorders) suite, supported by a research grant from Pfizer. It is a public-domain instrument that is free to use, reproduce, and translate, and it has been adapted into more than 100 languages. The PHQ-9 has become the most widely used depression screener in primary care, hospitals, and mental health research worldwide.
What the PHQ-9 measures
The PHQ-9 measures how often, over the past two weeks, you have experienced the nine core symptoms that the DSM (Diagnostic and Statistical Manual of Mental Disorders) uses to define a major depressive episode. The items cover low mood, loss of interest or pleasure, sleep disturbance, low energy, appetite changes, feelings of failure or self-criticism, difficulty concentrating, noticeably slowed or restless behavior, and thoughts of self-harm or being better off dead. A final question asks how much these symptoms have interfered with daily life — work, home tasks, or relationships — which adds a functional-impact dimension to the symptom count.
How the PHQ-9 is administered
The PHQ-9 is a self-report questionnaire that takes about 3 to 5 minutes to complete. Each of the 9 items asks 'Over the last two weeks, how often have you been bothered by [symptom]?' Response options are scored 0 (not at all), 1 (several days), 2 (more than half the days), and 3 (nearly every day). The questionnaire can be completed on paper, on a screen, or with a clinician reading the items aloud — research shows the format does not change the result. The two-week recall period is chosen intentionally to match the DSM criterion for a major depressive episode, so a current PHQ-9 score reflects your present state.
Who uses the PHQ-9
The PHQ-9 is used routinely in primary care, integrated behavioral health, mental health specialty clinics, hospital settings, and clinical research. The U.S. Preventive Services Task Force recommends that all adults — including pregnant and postpartum patients — be screened for depression in primary care when adequate follow-up systems are available, and the PHQ-9 is one of the instruments most commonly used to do so. Many medical systems include the PHQ-9 in electronic health records and have patients complete it before routine visits. Outside clinical settings it is also widely used in research, public health surveys, and integrated mental-health programs.
PHQ-9 is a screening tool, not a diagnosis
It is essential to understand that the PHQ-9 is a screening instrument — it can indicate whether further evaluation for depression is warranted, but it cannot diagnose depression on its own. A high score suggests that a clinician should follow up with a more comprehensive assessment. A low score does not rule out depression or other mental health conditions; if you are concerned about your mental health, talk to a clinician regardless of your score. Item 9 (thoughts of self-harm or being better off dead) is taken seriously regardless of the total score and warrants prompt clinical attention. If you are in crisis right now, call or text 988 (Suicide & Crisis Lifeline) for immediate support in the United States.
How to score and interpret your results
The PHQ-9 is scored by adding up the nine item responses to produce a single total between 0 and 27. Each item asks how often a symptom has bothered you over the past two weeks, and each response is worth a fixed number of points.
Response anchors are identical for all nine items:
- 0 — Not at all
- 1 — Several days
- 2 — More than half the days
- 3 — Nearly every day
The sum of those nine numbers is your total score. A clinician then maps that total to a severity band and a suggested next step. The bands below come from the published PHQ-9 scoring guidance used widely in primary care and HIV-specialty settings. They line up with the original validation thresholds reported by Kroenke and colleagues in 2001. That team found that scores of 5, 10, 15, and 20 mark the boundaries between minimal, mild, moderate, moderately severe, and severe symptoms.
PHQ-9 severity bands and recommended action
| PHQ-9 score | Severity level | Typical recommended action |
|---|---|---|
| 0–4 | None–minimal | None |
| 5–9 | Mild | Watchful waiting; repeat at follow-up |
| 10–14 | Moderate | Treatment plan with counseling and/or pharmacotherapy |
| 15–19 | Moderately severe | Active treatment with medication and/or psychotherapy |
| 20–27 | Severe | Immediate pharmacotherapy; expedited specialist referral if indicated |
Source: PHQ-9 scoring guidance, National HIV Curriculum.
A few interpretation rules sit on top of that table. First, the PHQ-9 is a screening instrument, not a diagnosis. A score in any band only tells a clinician how likely depression is and how intense the symptoms appear, not whether you meet formal diagnostic criteria. Second, scores below 5 rarely correspond to a depressive disorder, while scores of 15 or higher typically signal major depression and warrant a structured clinical assessment.
Item 9 overrides the total
There is one rule that takes precedence over the score-band table. Any non-zero response on item 9 — the question about thoughts of being better off dead or of hurting yourself — requires immediate clinical follow-up regardless of the total score. A person can have a low or moderate total and still need urgent attention because of that single item. If item 9 is non-zero and you are in immediate danger, contact the 988 Suicide & Crisis Lifeline (call or text 988 in the United States) or your local emergency number.
What a positive screen means — and what it doesn’t
A “positive” PHQ-9 screen — usually defined as a total score of 10 or higher — does not mean you have been diagnosed with depression. It means the questionnaire has flagged a pattern of symptoms that, in validation studies, sorted into the “major depression” group about 88% of the time at that cutoff. The PHQ-9 is a screening tool, not a diagnosis, and the clinically meaningful step is what happens after the screen, not the screen itself.
What a clinician typically does next
When a primary-care or mental-health clinician reviews an elevated PHQ-9, they usually combine the screening result with a fuller workup. Standard diagnostic steps for depression include:
- Taking a medical history, with the requirement that symptoms be present most days for at least two weeks
- Ordering medical tests to exclude other conditions that could account for the symptoms
- A physical examination
- A formal mental-health evaluation
A non-zero item 9 prompts a more detailed suicide-risk assessment by a clinician competent to perform it. Because depression frequently co-occurs with other chronic conditions such as heart disease and diabetes, a clinician may also review your medical history and current medications as part of the workup. One example of a lab test commonly considered in a depression workup — to rule out a treatable medical cause of mood and energy symptoms — is the TSH (thyroid stimulating hormone) test.
What a low score does — and does not — rule out
A low PHQ-9 score (0–4) reduces the likelihood of a current major depressive episode, but it does not rule out depression entirely, nor does it rule out other mental-health conditions. The PHQ-9 only measures the nine DSM symptoms of depression over a two-week window — it is silent on anxiety, trauma, substance use, bipolar disorder, psychosis, and longer-running mood patterns. If you are worried about your mental health, the right move is to talk to a clinician regardless of your score.
How accurate is the PHQ-9?
The PHQ-9 is one of the most thoroughly validated depression screeners in primary care. The original 2001 validation study by Kroenke, Spitzer, and Williams enrolled approximately 6,000 patients across primary-care and obstetrics-gynecology clinics, with 580 receiving blinded interviews by mental-health professionals as the diagnostic standard.
Across that cohort, the instrument showed strong psychometric properties:
- Sensitivity 88% and specificity 88% for major depression at a cutoff of 10 or higher
- Area under the ROC curve of 0.95, indicating excellent ability to discriminate people with and without depression
- Cronbach’s alpha of 0.89 in primary care (0.86 in obstetrics-gynecology) — strong internal consistency
- Test-retest correlation of 0.84 between clinic and telephone administration
The U.S. Preventive Services Task Force, in its 2023 recommendation, reports that the PHQ-9 demonstrates approximately 85% sensitivity and 85% specificity at standard cutoffs. On that evidence, the USPSTF gives depression screening a Grade B recommendation for all adults aged 19 and older, including pregnant and postpartum patients and adults 65 and older, when adequate follow-up systems are in place.
Two practical notes sit alongside those numbers. First, accuracy in a research cohort and accuracy in everyday clinical use are not identical. Sensitivity and specificity describe how the instrument behaved against blinded interviews in the original 6,000-patient validation, and the screen still depends on the patient answering honestly about the past two weeks. Second, the PHQ-9 is brief by design: a clinician needs less than three minutes to review a completed questionnaire and less than one minute to score it.
Limitations and considerations
The PHQ-9 is fast, validated, and free, but it has real boundaries. Knowing them keeps a score in the right context.
What the PHQ-9 does not screen for
The instrument only covers the nine DSM symptoms of major depression. It does not screen for anxiety, post-traumatic stress, substance use, eating disorders, psychosis, or bipolar disorder. Depression often co-occurs with anxiety, and many clinicians pair the PHQ-9 with the GAD-7 (Generalized Anxiety Disorder-7) for that reason. The GAD-7 was developed by the same research team that built the PHQ family of screeners.
Depression subtypes the PHQ-9 can miss
Depression comes in several forms, and a single PHQ-9 administration may not distinguish among them:
- Persistent depressive disorder (dysthymia) — less severe but longer-lasting symptoms, typically lasting two years or more
- Seasonal affective disorder — depressive episodes that follow a seasonal pattern
- Bipolar disorder — depressive episodes that alternate with periods of mania or hypomania
- Depression with psychotic features — depression accompanied by hallucinations or delusions
The PHQ-9 measures symptom intensity over a two-week window, so it can register a depressive episode regardless of subtype but cannot, on its own, identify which subtype is present. A clinician makes that distinction through history, longitudinal follow-up, and structured assessment.
Somatic overlap and self-report bias
Several PHQ-9 items — sleep disturbance, fatigue, appetite change, concentration problems, slowed movement — overlap with symptoms of common chronic medical conditions. Depression frequently coexists with diabetes, cancer, and heart disease, and it is linked to comorbid conditions including heart disease and diabetes in the broader NIMH literature. In patients with those conditions, somatic items can inflate the total even when mood symptoms are mild.
Self-report instruments also depend on the respondent’s honest disclosure and accurate recall of the past two weeks, which means a score can shift with stigma, acute stressors, or memory. The PHQ-9 has adaptations for specific populations (for example, the PHQ-A for adolescents), but the adult version was validated in adult primary-care and obstetrics-gynecology populations and should be interpreted with the population in mind.
What to do with your results
Whatever your score, the most useful next step is to share the completed questionnaire with a clinician — either a primary-care provider or a mental-health professional. The PHQ-9 is a screening tool, not a diagnosis, and a clinician’s review of the items adds the context the total alone cannot provide.
What to bring to the visit
A few things make the conversation more productive:
- The completed PHQ-9 with every item answered, including item 9
- A short note on when the symptoms started and what, if anything, has changed recently
- A list of current medications and major medical conditions, since depression can coexist with chronic conditions such as diabetes, cancer, or heart disease
- A note on alcohol or substance use, sleep patterns, and stressors over the past two weeks
- Any prior history of depression, anxiety, or other mental-health conditions in you or close family
What a clinician may discuss
Evidence-based treatments for depression exist and have been studied for decades. The major categories include psychotherapy (such as cognitive behavioral therapy or brief counseling) and antidepressant medication, used alone or in combination. Light therapy is one established option for seasonal patterns, and for severe or treatment-resistant depression, advanced interventions such as electroconvulsive therapy or repetitive transcranial magnetic stimulation may be considered. Choosing among these options is a clinical decision based on your history, symptom severity, prior response to treatment, and personal preferences — it is not something a screening score alone can answer.
Tracking change over time
Because the PHQ-9 produces a numeric total, it can also be used to monitor symptom severity over time, not just to screen. Repeating the PHQ-9 at regular intervals during care lets you and your clinician see whether symptoms are improving, plateauing, or worsening. The instrument’s strong test-retest reliability (correlation 0.84) and brief administration time make it well suited to that role.
If item 9 is non-zero
If you marked anything other than “Not at all” on item 9, treat that as the priority. The PHQ-9 scoring guidance is explicit: any non-zero response on item 9 requires immediate clinical follow-up regardless of the total score. If you are in immediate danger of harming yourself, call or text 988 (Suicide & Crisis Lifeline) in the United States, or go to the nearest emergency department.
Frequently asked questions
What is the PHQ-9?
The PHQ-9 (Patient Health Questionnaire-9) is a brief, 9-item self-report screener for depression symptoms over the past two weeks. It was developed by Spitzer, Kroenke, and Williams as part of the PRIME-MD family of primary-care screeners and is free to use without permission.
How is the PHQ-9 scored?
Each of the nine items is scored from 0 (“Not at all”) to 3 (“Nearly every day”), and the nine item scores are added for a total between 0 and 27. Scores of 5, 10, 15, and 20 mark the lower edges of mild, moderate, moderately severe, and severe symptom bands respectively.
What does my PHQ-9 score mean?
Scores of 0–4 suggest minimal symptoms; 5–9 mild; 10–14 moderate; 15–19 moderately severe; and 20–27 severe. The score is a screening signal, not a diagnosis — a clinician’s evaluation is what determines whether a depressive disorder is present and what to do about it.
Where can I download the PHQ-9 PDF?
The PHQ-9 and other PHQ screeners are public-domain instruments and can be downloaded directly from the official PHQ Screeners site (phqscreeners.com). No permission is required to reproduce, translate, display, or distribute them.
Is the PHQ-9 the same as the PHQ-2?
No. The PHQ-2 is an even shorter version, used as an ultra-brief two-item depression screen before deciding whether to administer the full PHQ-9. Both are part of the same PHQ family developed from PRIME-MD.
Should I take the PHQ-9 and GAD-7 together?
Many clinicians pair the two because the PHQ-9 does not screen for anxiety. The GAD-7 (Generalized Anxiety Disorder-7) was developed by the same research team and covers seven prevalent anxiety symptoms, making the PHQ-9 plus GAD-7 a common combined depression-and-anxiety screen in primary care.
Is the PHQ-9 free to use?
Yes. The PHQ-9 is in the public domain, and the official PHQ Screeners site states that no permission is required to reproduce, translate, display, or distribute the PHQ family of screeners.
When to seek immediate help
The PHQ-9 includes a direct question about thoughts of self-harm, so anyone using the instrument should know where to turn if those thoughts feel urgent. The scoring guidance is clear: any non-zero answer on item 9 requires immediate clinical follow-up regardless of the total score.
Seek immediate help if any of the following apply:
- You answered anything other than “Not at all” on item 9 of the PHQ-9 (thoughts of being better off dead or of hurting yourself), even if your total score is low
- You are having active thoughts of suicide or self-harm right now
- You have a plan or the means to harm yourself
- Someone you live with or care for is in immediate danger
- You feel unable to keep yourself safe until your next appointment
Crisis resources
- 988 Suicide & Crisis Lifeline — call or text 988 anywhere in the United States for free, confidential support, available 24/7
- 911 or your nearest emergency department — for active danger to yourself or someone else
- Outside the United States — contact your local emergency number or a recognized national crisis line
If the danger is not immediate but symptoms are severe — for example, a PHQ-9 score in the 20–27 (severe) band — the scoring guidance recommends expedited specialist referral rather than waiting. Contact your primary-care clinician’s after-hours line, an urgent-care mental-health service, or a crisis line for help arranging same-day or next-day evaluation. The PHQ-9 is a screening tool, not a diagnosis, but a high score combined with any safety concern is a reason to act sooner, not later.