PHQ-9 PDF Download
Patient Health Questionnaire-9
Gold standard depression screening tool. Assesses frequency of depressive symptoms over the past two weeks.
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Catch early warning signs before the next session
The PHQ-9 is used by over 10,000 healthcare organizations worldwide
When to Use the PHQ-9
PHQ-9 Scoring Guide (Score Range: 0-27)
| Score | Severity Level | Clinical Action |
|---|---|---|
| 0-4 | Minimal | Monitor |
| 5-9 | Mild | Watchful waiting |
| 10-14 | Moderate | Treatment recommended |
| 15-19 | Moderately Severe | Active treatment |
| 20-27 | Severe | Immediate intervention |
Key Features of the PHQ-9
- Item 9 screens for suicidal ideation
- Validated globally
- Public domain
What the PHQ-9 Actually Measures
The PHQ-9 directly maps to the nine DSM-5 diagnostic criteria for Major Depressive Disorder (MDD). It measures the frequency of depressive symptoms over the past two weeks, providing both a severity score and a diagnostic screening tool.
Anhedonia (Item 1)
Loss of interest or pleasure in activities - often the first symptom to emerge and last to resolve
Depressed Mood (Item 2)
Feeling down, depressed, or hopeless - the core affective symptom
Sleep Disturbance (Item 3)
Insomnia or hypersomnia - affects 80% of patients with depression
Fatigue (Item 4)
Feeling tired or having little energy - often mistaken for medical conditions
Appetite Changes (Item 5)
Poor appetite or overeating - can indicate depression severity
Guilt/Worthlessness (Item 6)
Feeling bad about yourself - a cognitive symptom that responds well to therapy
Concentration (Item 7)
Trouble concentrating - impacts work and daily functioning
Psychomotor Changes (Item 8)
Moving or speaking slowly/restlessly - observable by others
Suicidal Ideation (Item 9)
Thoughts of self-harm or death - requires immediate clinical attention if endorsed
What Scores Actually Mean in Practice
Subclinical symptoms. Patient may have occasional low days but maintains normal functioning.
"I have my ups and downs like everyone, but I'm doing okay overall."
Noticeable symptoms that may affect quality of life but often don't require formal treatment. Watchful waiting is appropriate.
"I've been feeling a bit off lately. Some days are harder than others, but I can push through."
Clinically significant depression. Treatment is typically warranted. Patients often report functional impairment at work or home.
"I'm struggling to keep up with things. I don't enjoy what I used to. My family has noticed I'm different."
Significant depression requiring active treatment. Combination of medication and therapy often indicated. High risk for treatment dropout.
"Getting through each day is exhausting. I've been calling in sick. I don't see things getting better."
Severe depression with likely significant functional impairment. Consider psychiatric consultation, intensive treatment, or higher level of care.
"I can barely function. Everything feels impossible. I don't know how much longer I can do this."
Common Misinterpretations
A PHQ-9 of 10+ means the patient definitely has Major Depression
The PHQ-9 is a screening tool, not a diagnostic instrument. A score of 10+ has 88% sensitivity but also produces false positives. Clinical interview is required to confirm diagnosis and rule out medical causes, grief, or adjustment disorders.
Lower scores always mean the patient is getting better
Score decreases can reflect genuine improvement, but also emotional blunting from medication, reduced insight, or social desirability bias. Look for functional improvement alongside score changes.
Item 9 (suicidal ideation) endorsed at any level requires hospitalization
Item 9 screens for the full spectrum from passive death wishes to active planning. A response of "1" (several days) often reflects passive ideation. Conduct a thorough safety assessment but don't over-react to low endorsements.
The PHQ-9 captures all aspects of depression
The PHQ-9 focuses on DSM criteria but misses atypical symptoms (rejection sensitivity, leaden paralysis), anxiety comorbidity, and quality of life. Consider pairing with GAD-7 and functional measures.
A score that hasn't changed means treatment isn't working
Response typically takes 4-8 weeks. A 5-point reduction is clinically meaningful. Patients may experience symptom improvement in some domains before total score reflects change.
What a PHQ-9 of 20 Usually Means for Treatment Retention
Patients scoring 20+ on the PHQ-9 are at significantly elevated risk for treatment dropout. Research shows that severe depression scores correlate with lower treatment adherence, higher no-show rates, and earlier treatment termination—often precisely when they need care most.
Key Retention Strategies:
- Patients with PHQ-9 ≥20 are 2-3x more likely to drop out of treatment in the first 30 days
- Severe fatigue and hopelessness make attending appointments feel impossible
- Cognitive symptoms (poor concentration, indecision) interfere with treatment planning
- Higher scores often mean more logistical barriers (job loss, relationship problems)
- Early and frequent contact in the first 2-4 weeks is critical for retention
- Consider shorter, more frequent sessions initially rather than standard weekly cadence
- Phone or text check-ins between sessions can significantly improve retention
- Involve family/support system when possible to help with appointment attendance
- Frame treatment as a team effort—patients with severe depression need external structure
Frequently Asked Questions About the PHQ-9
What is the PHQ-9?
The PHQ-9 (Patient Health Questionnaire-9) is a 9-item self-report questionnaire that screens for the presence and severity of depression. It's based on DSM criteria and is the most widely used depression screening tool in clinical practice.
Is the PHQ-9 free to use?
Yes, the PHQ-9 is in the public domain and completely free to use. There are no licensing fees or permissions required.
How do you score the PHQ-9?
Each of the 9 items is scored from 0 (not at all) to 3 (nearly every day). Total scores range from 0-27. Scores of 5, 10, 15, and 20 represent cutpoints for mild, moderate, moderately severe, and severe depression respectively.
When should I use the PHQ-9?
Use the PHQ-9 for initial depression screening, monitoring treatment response, and measuring symptom severity. It's appropriate for adults in primary care, mental health, and specialty settings.
What does a PHQ-9 score of 10 or higher mean?
A score of 10 or higher suggests moderate depression and typically warrants treatment consideration. It has 88% sensitivity and 88% specificity for detecting major depressive disorder.
You're not alone, and help is available.
If you are experiencing thoughts of suicide or feel at risk of harming yourself, please contact emergency services right away or reach out to the 988 Suicide & Crisis Lifeline (call or text 988 in the U.S.). If you are in immediate danger, call 911.
Research Supporting Outcome Measurement
Evidence-based research on the importance of patient-reported outcome measures in behavioral health treatment.
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