PHQ-15 PDF Download
Patient Health Questionnaire-15
Validated measure for somatic symptom severity. Covers 15 common physical symptoms.
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Catch early warning signs before the next session
The PHQ-15 is the standard measure for somatic symptom severity
When to Use the PHQ-15
PHQ-15 Scoring Guide (Score Range: 0-30)
| Score | Severity Level | Clinical Action |
|---|---|---|
| 0-4 | Minimal | No intervention |
| 5-9 | Low | Watchful waiting |
| 10-14 | Medium | Consider treatment |
| 15-30 | High | Active treatment recommended |
Key Features of the PHQ-15
- Covers 15 most common symptoms
- Pairs with PHQ-9/GAD-7
- Public domain
What the PHQ-15 Actually Measures
The PHQ-15 assesses the 15 most common somatic symptoms seen in outpatient settings. These symptoms account for over 90% of physical complaints in primary care. The measure captures symptom burden regardless of whether symptoms have identified medical causes—it's about distress, not etiology.
Pain Symptoms (Items 1-4, 14)
Stomach pain, back pain, limb pain, headaches, chest pain—the most common somatic complaints
Cardiopulmonary (Items 5-6)
Dizziness and shortness of breath—often associated with panic and anxiety
Gastrointestinal (Items 7-9)
Constipation, nausea, and indigestion—the gut-brain connection in physical symptoms
Neurological/Fatigue (Items 10-12)
Fatigue, sleep problems, and fainting—overlaps significantly with depression
Cardiac/Sexual (Items 13, 15)
Heart racing/pounding and sexual problems—autonomic and stress-related symptoms
What Scores Actually Mean in Practice
Low somatic symptom burden. Physical symptoms are not a significant source of distress or healthcare seeking.
"I feel pretty healthy. Sure, I get the occasional headache, but nothing that really bothers me."
Mild somatic symptoms present. May warrant monitoring, especially if symptoms cluster in one system or are increasing.
"I've been having some stomach issues and feeling more tired than usual. It's annoying but I can function."
Moderate somatic symptom burden associated with functional impairment. Screen for depression and anxiety; consider mind-body approaches.
"My body is always giving me trouble—headaches, stomach pain, fatigue. I've seen several doctors but no one can find what's wrong."
High somatic symptom burden. Strong association with depression, anxiety, and functional impairment. Integrated treatment addressing both physical and psychological components indicated.
"I'm in pain or discomfort almost all the time. It's affecting my work, my relationships, everything. Doctors keep telling me nothing's wrong but I know something is."
Common Misinterpretations
High PHQ-15 scores mean symptoms are 'all in the patient's head'
The PHQ-15 measures symptom burden, not symptom validity. High scores can reflect real medical conditions, somatic symptom disorder, or both. Never dismiss symptoms as 'just psychological.'
The PHQ-15 distinguishes medically explained from unexplained symptoms
The PHQ-15 doesn't assess etiology. A patient with fibromyalgia, another with medically unexplained pain, and another with cancer pain could all score high. The score reflects burden, not cause.
Physical symptoms should be fully worked up before addressing psychology
Parallel attention to both physical and psychological factors is more effective than sequential. Addressing anxiety/depression often improves physical symptoms regardless of their cause.
Low PHQ-15 scores mean no somatization
Some patients with significant health anxiety focus on one specific symptom rather than multiple symptoms. They may score low on PHQ-15 but still have functionally impairing somatic concerns.
The PHQ-15 is only useful in primary care
The PHQ-15 is valuable in mental health settings to identify the somatic component of depression/anxiety, and in specialty medical settings to quantify symptom burden for conditions like IBS or chronic pain.
What a PHQ-15 of 15+ Usually Means for Treatment Retention
Patients with high somatic symptom burden present unique retention challenges. They often seek medical care for physical complaints and may resist psychological framing. Treatment requires careful attention to how symptoms are discussed and validated.
Key Retention Strategies:
- These patients often feel dismissed by healthcare providers—validate their physical suffering before introducing psychological concepts
- Avoid the word 'psychological' initially; frame as 'stress affects the body' or 'the brain-body connection'
- High PHQ-15 patients are often high healthcare utilizers—coordinate care to reduce fragmented treatment seeking
- Comorbid depression and anxiety are the rule; screen with PHQ-9 and GAD-7 and treat aggressively
- Mind-body treatments (CBT for somatic symptoms, relaxation training, mindfulness) have strong evidence base
- Set realistic expectations—symptom improvement may be gradual and may mean 'coping better' rather than symptom elimination
- These patients may drop out if they feel their physical symptoms aren't being taken seriously
- Frequent brief appointments often work better than infrequent longer ones—mirrors their healthcare-seeking pattern
- Involving primary care in mental health treatment improves credibility and retention
Frequently Asked Questions About the PHQ-15
What is the PHQ-15?
The PHQ-15 is a 15-item self-report questionnaire that assesses the severity of somatic (physical) symptoms over the past 4 weeks.
What does the PHQ-15 measure?
It measures 15 common physical symptoms including pain, fatigue, and gastrointestinal issues that may have psychological components.
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