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PHQ-9 — Patient Health Questionnaire

Kroenke, Spitzer & Williams, 20019 items · single scale~90 sec (self-report)DSM-aligned · sensitive to changeRU · EN
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CalculatorAboutCut-offsClinical useSourcesFAQ

What the PHQ-9 measures

The Patient Health Questionnaire-9 (PHQ-9, Kroenke, Spitzer & Williams, 2001) is a 9-item self-report measure of depressive symptom severity over the past two weeks. The total ranges 0–27. Each of the 9 items maps one-to-one onto a DSM major depressive episode criterion, which makes the PHQ-9 simultaneously a screening tool and a severity scale.

PHQ-9 grew out of PRIME-MD and has become the most widely used instrument for depression screening and monitoring in primary care and in measurement-based care research. Compared with BDI-II (21 items, cognitive emphasis) and MADRS (10 items, clinician-rated), the PHQ-9 is shorter, simpler (~90 seconds to complete) and directly anchored in DSM criteria.

PHQ-9 is a severity and screening scale, not a diagnostic test. A score ≥10 indicates clinically significant depressive symptoms and warrants clinical assessment; the formal diagnosis is a clinician's call.
Each of the 9 items is scored 0 ("not at all") to 3 ("nearly every day") for the past two weeks. The total ranges 0–27. The scale is completed by the patient. Pfizer provides PHQ-9 free of charge; no separate permission is required to reproduce, translate or distribute it.

Severity cut-offs

PHQ-9 — total-score severity bands (per Kroenke et al., 2001)
Score rangeSeverityClinical meaning
0–4MinimalMinimal or no depressive symptoms
5–9MildMild symptoms — watchful waiting
10–14ModerateClinically significant — consider treatment
15–19Moderately severeModerately severe — active treatment indicated
20–27SevereSevere — urgent assessment and intensive treatment

Use in clinical practice

PHQ-9 is used in two ways: (1) screening for depression in primary or specialist care — a score ≥10 indicates clinically significant depressive symptoms and warrants further clinical assessment; (2) as a severity scale for baseline measurement and for monitoring change during treatment at 2–4-week intervals.

Screening threshold

A score ≥10 is the standard threshold for clinically significant depressive symptoms (sensitivity ≈ 85–88%, specificity ≈ 85–88% for major depressive episode in primary care; Kroenke 2001; IPD meta-analysis Levis 2019, N = 17 357 across 58 studies). It is a threshold for clinical assessment, not a diagnosis.

MBC monitoring

Repeat the PHQ-9 every 2–4 weeks. Treatment response — a ≥50% reduction from baseline. Remission — PHQ-9 ≤4. An alternative minimal clinically important improvement is a reduction of ≥5 points (McMillan 2010).

IMPORTANT: item 9 concerns thoughts of self-harm — any positive response (>0) warrants a direct suicide-risk assessment (the PHQ-9 is not a risk-assessment tool). With high totals (moderately severe / severe) prioritise clinical assessment and a safety check. Limitations: somatic items (sleep, appetite, fatigue) can inflate the score in physical illness; the optimal cut-off can vary across populations (Manea 2012).

Sources

  • Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606–613.
  • Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282(18):1737–1744.
  • Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012;184(3):E191–E196.
  • Levis B, Benedetti A, Thombs BD, et al. Accuracy of the PHQ-9 for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476 (N = 17 357 across 58 studies).
  • McMillan D, Gilbody S, Richards D. Defining successful treatment outcome in depression using the PHQ-9: a comparison of methods. Journal of Affective Disorders. 2010;127(1–3):122–129.
  • Kroenke K, Spitzer RL, Williams JBW, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry. 2010;32(4):345–359.
  • Pfizer PHQ Screeners — official PHQ-9 distribution portal: "No permission required to reproduce, translate, display or distribute".
PHQ-9 calculator
0 of 9 items completed9 items left
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. Any positive response warrants a direct suicide-risk assessment.
Total score (PHQ-9)0 / 27

Clinical use of the PHQ-9

Questions about scoring, severity bands, and the scale's limits

Add the scores of all 9 items (each 0–3); the total ranges 0–27. There are no multipliers or reverse items. All 9 items must be answered — skipping any makes the result invalid.
Canonical bands (Kroenke et al., 2001): 0–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe. These are severity bands, not a diagnostic threshold. A score ≥10 indicates clinically significant depressive symptoms and warrants clinical assessment.
HADS measures both anxiety and depression (7 items each), deliberately omits somatic items, and is widely used in general or hospital medicine. PHQ-9 focuses on depression only, maps to the 9 DSM criteria, and includes somatic items (sleep, appetite, fatigue, psychomotor change) — so PHQ-9 is diagnostically richer, but HADS is more accurate when somatic items could distort the assessment.
PHQ-9 is short (9 items), DSM-mapped, and suits screening and rapid monitoring; BDI-II is longer (21 items, range 0–63), grades severity in more detail and emphasises cognitive content (self-criticism, pessimism, guilt). Both are self-reports; neither replaces diagnosis. PHQ-9 is free from Pfizer; BDI-II is proprietary (Pearson).
The diagnostic algorithm is described in the source paper (Kroenke et al., 2001) as a "provisional diagnosis": MDD is provisionally indicated when ≥5 items score ≥2 ("more than half the days" or more often), with at least one of them being item 1 (anhedonia) or item 2 (depressed mood); item 9 counts at any positive score. This algorithm is a guide; final diagnosis requires clinical assessment by a professional. This page does not apply the algorithm automatically — it computes a severity score.
Repeat the PHQ-9 every 2–4 weeks from the start of treatment. Clinical response — a ≥50% reduction from baseline (e.g., from 18 to 9). Remission — PHQ-9 ≤4. An alternative minimal clinically important improvement is a reduction of ≥5 points. Regular repeated measurements allow objective tracking of response to psychotherapy and/or pharmacotherapy.
No. The PHQ-9 is a screening/severity scale, not a diagnostic test. A score ≥10 indicates clinically significant depressive symptoms and warrants clinical assessment, but is not equivalent to a diagnosis. A formal depressive-disorder diagnosis requires structured clinical assessment by a professional. High scores or thoughts of self-harm (a positive item 9) warrant urgent clinical assessment.
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Used together with PHQ-9

Anxiety / Depression · self-report
HADS

A two-subscale self-report without somatic items; useful in general medicine or when PHQ-9 somatic items could inflate the score.

Open
Depression · self-report
BDI-II

A detailed 21-item self-report of depression severity (0–63) with stronger cognitive content (self-criticism, pessimism); useful for in-depth severity assessment.

Open
Depression · clinician-rated
MADRS

A clinician-rated depression severity scale (10 items, 0–60) scored from a structured interview; complements the PHQ-9 from the observer's side.

Open
Depression · clinician-rated
HAM-D

The classic clinician-rated depression severity scale (17 items, 0–52); a standard in antidepressant RCTs.

Open
The PHQ-9 is a self-report questionnaire — the patient completes it for the past two weeks. It is a screening and monitoring tool, not a diagnostic test. Results reflect symptom severity and are a guide rather than a diagnosis. A score ≥10 indicates clinically significant depressive symptoms and warrants clinical assessment by a professional. Any positive response to item 9 (thoughts of self-harm) — and any high total — warrants urgent clinical assessment, including direct suicide-risk evaluation.
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