PHQ-9
Patient Health Questionnaire-9
Nine-item self-report screen and severity measure for depression, mapped 1:1 to DSM criteria.
The PHQ-9 is the nine-item depression module of the Patient Health Questionnaire developed by Kroenke, Spitzer and Williams (2001). It maps 1:1 onto the DSM criteria for major depressive disorder and is the most widely used depression screen in primary care and behavioral-health settings.
What it measures
Frequency over the past two weeks of each of the nine DSM-5 symptoms of major depressive disorder. Item 9 separately assesses passive suicidal ideation and self-harm thoughts. A tenth functional impact question is sometimes included.
Scoring and bands
Cutoffs
A score of ≥10 has 88% sensitivity and 88% specificity for major depression in primary care samples. A 5-point change is generally considered clinically meaningful.
How to talk about the score
Share the total and what the band means, then talk about which items drove the score. Always discuss item 9 directly — never skip it. Frame the measure as a tool you use with everyone, not a verdict on the person.
Limitations
- Self-report — vulnerable to under- or over-reporting
- Two-week window may miss episodic patterns
- Doesn't distinguish unipolar from bipolar depression
- Item 9 is a screen, not a risk assessment by itself
Best used for
- Routine intake screening
- Session-to-session tracking
- Treatment response monitoring
- Primary-care depression screening
The PHQ-9 items
Over the last two weeks, how often have you been bothered by the following problems?
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself — or that you are a failure or have let yourself or your family down
- Trouble concentrating on things, such as reading the newspaper or watching television
- Moving or speaking so slowly that other people could have noticed — or the opposite, being so fidgety or restless that you have been moving around a lot more than usual
- Thoughts that you would be better off dead or of hurting yourself in some way(Item 9 — suicidal ideation screen)
PHQ-9 scoring — total score and severity bands
Each item is scored 0–3. Total range is 0–27. Bands: 0–4 minimal or none, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe. The standard clinical cutoff of ≥10 has 88% sensitivity and 88% specificity for major depressive disorder. A 5-point change is generally considered clinically meaningful.
What does a PHQ-9 score of 10, 15, or 20 mean?
10 = moderate depression and the standard threshold to consider active treatment. 15 = moderately severe — typically warrants a structured intervention (psychotherapy, pharmacotherapy, or both). 20 or higher = severe depression; safety assessment and active treatment are indicated. Always discuss item 9 (suicidal ideation) regardless of total score.
PHQ-9 item 9 and safety
Item 9 asks about thoughts of being better off dead or of self-harm. Any non-zero response should prompt a follow-up safety conversation — but item 9 is a screen, not a risk assessment. A client can score 0 on item 9 and still be at risk. Use a structured safety assessment (such as the C-SSRS) whenever clinical signals warrant it.
Free PHQ-9 PDF and printable versions
The PHQ-9 is in the public domain (free for clinical, educational, and research use, including translations). It was developed by Drs. Spitzer, Williams and Kroenke with an educational grant from Pfizer Inc. Send the PHQ-9 interactively from your TherapistAssist account to track total scores and item-level trend over time.
Frequently asked questions about the PHQ-9
What if a client scores 0 on item 9 but presents with risk?
Trust the clinical picture. The PHQ-9 is a screen, not a risk assessment. Conduct a full safety assessment any time clinical signals warrant it, regardless of the item-9 score.
How often should I re-administer?
Weekly to monthly is typical during active treatment. The measure is sensitive enough to detect change at that interval and brief enough to fit into a session.
Is the PHQ-9 valid for adolescents?
The PHQ-A is the adolescent-adapted version (ages 11–17) and is preferred for that age group. The standard PHQ-9 can be used 12+ in many settings.
Is the PHQ-9 free to use?
Yes. The PHQ-9 is in the public domain. No permission is required for clinical, educational, or research use.
How long does the PHQ-9 take?
Most clients complete the nine items in 2–3 minutes. Scoring takes well under a minute.
What is the PHQ-9 cutoff for depression?
A total score of ≥10 is the standard clinical cutoff and yields 88% sensitivity and 88% specificity for major depressive disorder.