PHQ-9 Scoring: Score Ranges, Cut-Offs and a Free Calculator
The PHQ-9 has nine items, each scored 0 to 3 over the last two weeks, giving a total from 0 to 27. There are no reverse-scored items, no weighting and no subscales, so the arithmetic is simple — the skill is reading the total correctly, handling Item 9, and knowing how much change matters.
Below you will find the score ranges, an interactive calculator, the worked arithmetic on a real response pattern, the safety rule that overrides the total, and the response and remission thresholds used in measurement-based care.
The short answer
- Score each of the 9 items 0-3 and add them: total 0 to 27.
- Ranges: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
- 10 or more is the standard cut-off for probable major depression (about 88% sensitivity and 88% specificity).
- Any score above 0 on Item 9 requires a suicide risk assessment in the same visit, whatever the total.
- Response is a 5-point drop or a 50% reduction; remission is a total below 5.
- The tenth question on difficulty at work and home is not added to the total.
Step-by-step scoring
Score range: 0-27 (nine items scored 0-3)
- 1Score each item 0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day.
- 2Add the nine items for a total from 0 to 27. There are no reverse-scored items, no weighting and no subscales.
- 3Apply the bands: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
- 4Read Item 9 on its own. Any response above 0 requires a same-visit suicide risk assessment regardless of the total.
- 5Optionally apply the diagnostic algorithm: 5 or more items at 2 or higher (Item 9 counts at 1 or higher), and one of those must be Item 1 or Item 2.
- 6Record the unscored functional-impairment question in the note alongside the total.
Score the PHQ-9 now
PHQ-9 score calculator
Over the last 2 weeks, how often have you been bothered by any of the following problems? Nothing is stored or sent — this runs entirely in your browser.
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 being so fidgety or restless that you have been moving a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way
0 of 9 items answered
Total: 0/ 27
Answer every item for a valid total — partial PHQ-9 scores should not be pro-rated.
Educational calculator only. A score is not a diagnosis and is not stored.
A worked example
| Item | Response and score |
|---|---|
| 1. Little interest or pleasure in doing things | Nearly every day = 3 |
| 2. Feeling down, depressed or hopeless | Nearly every day = 3 |
| 3. Trouble sleeping or sleeping too much | More than half the days = 2 |
| 4. Feeling tired or having little energy | Nearly every day = 3 |
| 5. Poor appetite or overeating | Several days = 1 |
| 6. Feeling bad about yourself or like a failure | More than half the days = 2 |
| 7. Trouble concentrating | More than half the days = 2 |
| 8. Moving or speaking slowly, or being restless | Several days = 1 |
| 9. Thoughts of being better off dead or of hurting yourself | Several days = 1 |
Total = 3 + 3 + 2 + 3 + 1 + 2 + 2 + 1 + 1 = 18, in the moderately severe band. It also meets the diagnostic algorithm: five items at 2 or higher including Item 1 and Item 2. And because Item 9 is above 0, a risk assessment and safety plan are required at this visit regardless of the total. A drop to 9 or below would count as a response, and below 5 as remission.
Score ranges and what to do next
| Score | Severity | Next step |
|---|---|---|
| 0-4 | Minimal or none | No treatment indicated on this measure. This is the remission target when tracking treatment — a final score under 5 is how remission is defined. |
| 5-9 | Mild depression | Watchful waiting, psychoeducation, behavioural activation, sleep and substance review. Repeat in two to four weeks rather than starting medication on this score alone. |
| 10-14 | Moderate depression | Probable major depression. Confirm diagnostically and start active treatment — psychotherapy, an antidepressant, or both. This is the standard screening cut-off. |
| 15-19 | Moderately severe depression | Active treatment indicated, usually medication plus psychotherapy. Increase visit frequency and assess suicide risk, function and support at every contact. |
| 20-27 | Severe depression | Immediate active treatment, expedited psychiatric referral, and a formal safety assessment. Consider higher level of care, and review for psychosis, catatonia and bipolarity before starting an antidepressant alone. |
Scoring mistakes to avoid
- Adding the tenth functional-impairment question into the total. It is not scored — but record it, because it often drives the level of care decision.
- Reading a low total as reassurance when Item 9 is above 0. Item 9 is assessed on its own, always.
- Pro-rating a total when an item is missing. Ask for the missing answer instead; an estimate can shift the score into the wrong band.
- Treating 10 as a diagnosis rather than a threshold for diagnostic assessment.
- Reading a 2 or 3 point change as improvement. Meaningful response is 5 points or a 50% reduction.
- Starting an antidepressant without screening for mania. The PHQ-9 does not detect bipolar depression.
- Missing medical contributors: hypothyroidism, anaemia, B12 deficiency, sleep apnoea, chronic pain, alcohol and sedative use.
What individual PHQ-9 scores mean
What does a PHQ-9 score of 5 mean?
Five is the bottom of the mild band. It means some depressive symptoms are present but usually below the level at which medication is indicated. Give psychoeducation, address sleep, activity and alcohol, and repeat the measure in two to four weeks.
What does a PHQ-9 score of 10 mean?
Ten is the standard cut-off for probable major depression, with roughly 88% sensitivity and 88% specificity. It indicates moderate depression and calls for diagnostic confirmation and active treatment rather than watchful waiting.
What does a PHQ-9 score of 15 mean?
Fifteen begins the moderately severe band. Combined psychotherapy and medication is the usual recommendation, visits should be more frequent, and suicide risk should be assessed at each contact.
What does a PHQ-9 score of 20 mean?
Twenty or more is severe depression. Treat immediately, arrange expedited psychiatric involvement, complete a formal safety assessment, and consider whether a higher level of care is needed.
What is a normal PHQ-9 score?
A total of 0 to 4 is minimal and is treated as the normal range. It is also the remission target: a post-treatment score below 5 is the standard definition of remission.
How much PHQ-9 change is clinically meaningful?
A drop of 5 points or more, or a 50% reduction from baseline, is the usual definition of treatment response. Smaller movements sit inside measurement error and should not be read as improvement.
Can the PHQ-9 diagnose depression?
No. It is a screening and severity measure. A score of 10 or more indicates probable major depression and requires a clinical interview to confirm the diagnosis and rule out bipolar disorder, grief, thyroid disease, anaemia, substance effects and medication side effects.
What does PHQ-9 Item 9 mean?
Item 9 asks about thoughts of being better off dead or of hurting oneself. Any score above 0 requires a same-visit suicide risk assessment and a safety plan, even when the total falls in the minimal or mild band.
The 9 PHQ-9 questions, word for word
Each question is introduced by the same stem: "Over the last 2 weeks, how often have you been bothered by any of the following problems?" Every item is answered on the same four-point scale — Not at all = 0, Several days = 1, More than half the days = 2, Nearly every day = 3.
- 1. Little interest or pleasure in doing things — 0 / 1 / 2 / 3
- 2. Feeling down, depressed or hopeless — 0 / 1 / 2 / 3
- 3. Trouble falling or staying asleep, or sleeping too much — 0 / 1 / 2 / 3
- 4. Feeling tired or having little energy — 0 / 1 / 2 / 3
- 5. Poor appetite or overeating — 0 / 1 / 2 / 3
- 6. Feeling bad about yourself, or that you are a failure, or have let yourself or your family down — 0 / 1 / 2 / 3
- 7. Trouble concentrating on things, such as reading the newspaper or watching television — 0 / 1 / 2 / 3
- 8. Moving or speaking so slowly that other people could have noticed, or being so fidgety or restless that you have been moving a lot more than usual — 0 / 1 / 2 / 3
- 9. Thoughts that you would be better off dead or of hurting yourself in some way — 0 / 1 / 2 / 3
- Tenth question (not scored into the total): If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all / Somewhat difficult / Very difficult / Extremely difficult.
PHQ-9 score ranges at a glance
- 0-4 minimal — normal range and the post-treatment remission target.
- 5-9 mild — subthreshold symptoms; monitor and re-measure in two to four weeks.
- 10-14 moderate — probable major depression; the standard screening cut-off.
- 15-19 moderately severe — combined treatment and closer follow-up.
- 20-27 severe — immediate treatment, psychiatric involvement, formal safety assessment.
The diagnostic algorithm, and when to use it
Alongside the severity total, the PHQ-9 supports a criteria-based reading: a probable major depressive episode requires five or more items scored 2 or higher — Item 9 counts at 1 or higher — and at least one of those must be Item 1 (loss of interest) or Item 2 (low mood).
The algorithm is more specific and less sensitive than the 10-point cut-off. In practice, use the cut-off for screening a population and the algorithm when documenting why a diagnosis was made, since it maps onto the DSM criteria the note has to support.
How often to repeat the PHQ-9
A single score screens. Repeat scores are what change decisions, and the interval should match how fast you expect the treatment to work.
In active treatment, measure every session or every two weeks. Expect partial movement by weeks four to six; a total that has not dropped by at least a quarter by week six to eight is the signal to increase the dose, switch, augment or intensify therapy rather than continue. In maintenance, every four to six weeks is enough to catch relapse early. In TMS or ketamine courses, weekly measurement is standard because the trajectory is the authorisation evidence.
Documenting response and remission for payers
Quality programmes and value-based contracts do not ask for average scores. They ask what proportion of patients with an elevated baseline reached response or remission inside a defined window — typically 3, 6 or 12 months.
That requires a baseline PHQ-9 in the record, a follow-up in the window, and both tied to the same patient and episode. HEDIS Depression Remission and Response measures are built on exactly this pattern, which is why practices that score on paper usually cannot report them.
PHQ-9 scoring questions
How do you score the PHQ-9?
Score each of the nine items from 0 (not at all) to 3 (nearly every day) and add them for a total from 0 to 27. Bands are 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe and 20-27 severe.
What is the PHQ-9 cut-off score?
Ten or higher is the standard cut-off for probable major depression and the point at which diagnostic assessment and active treatment are indicated.
Is the PHQ-9 free to use?
Yes. The PHQ-9 is in the public domain and can be reproduced, translated and built into software without permission or fee.
How is the tenth PHQ-9 question scored?
It is not scored. The functional-impairment question is recorded separately and used to inform level of care.
How often should the PHQ-9 be repeated?
At intake, then every session or every two weeks during active treatment, and every four to six weeks in maintenance. Repeat measurement is what allows response and remission to be documented.
What is the difference between the PHQ-9 and the PHQ-2?
The PHQ-2 is the first two PHQ-9 items scored 0-6 as an ultra-brief screen. A PHQ-2 of 3 or more should be followed by the full PHQ-9.
Is there a PHQ-9 for teenagers?
Yes. The PHQ-A adapts the wording and adds items for adolescents, and the PHQ-9 itself is validated from age 12.
What should happen if a patient endorses Item 9?
Any response above 0 requires a suicide risk assessment in the same visit, a safety plan, means restriction counselling and a documented follow-up interval, regardless of the total score.
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Scoring reference for clinicians and patients. Not medical advice, and no score is a diagnosis. See our medical disclaimer.