PHQ 9 Patient Health Questionnaire

Evaluates the depressive symptoms a patient may experience to determine depression severity.

In the text below the calculator there is more information about this mental health questionnaire and about the original study it is based on.

The PHQ 9 belongs to a series of mental health questionnaires which evaluate patient symptoms in search for a mental disorder, in this case, depression.

The tool consists of 9 items that relate to different depressive symptoms.

The patient is asked whether they consider they experience those symptoms, and if so, to rate the frequency.

The following table introduces the association between the PHQ 9 scores and depression severity stages:

Score Severity Recommendations
0 - 4 None No specific recommendations
5 - 9 Mild Monitoring symptoms
10 - 19 Moderate Referring for treatment
20 - 27 Severe Starting treatment and monitoring

Please answer the following questions by considering your behavior in the past 2 weeks:

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 slower or opposite - restless more than usual


Thoughts that you would be better off dead or of hurting yourself in some way

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PHQ 9 explained

This self report diagnosis tool evaluates the severity of depressive symptoms based on criteria from the DSM-IV guidelines. The patient is asked to review the past two weeks in respect to experiencing the following:

■ Losing interest in activities usually performed with pleasure.

■ Experiencing feelings of hopelessness, depression.

■ Sleep problems from falling asleep to too much sleep.

■ Lack of energy and feeling exhausted.

■ Eating disorders from lack or too much appetite.

■ Feelings of disappointment and lack of confidence.

■ Lack of concentration in simple actions.

■ Restlessness or extreme fatigue.

■ Self-harm or suicidal thoughts.

Each of the nine items are rated on the following scale:

■ Not at all (0 points);

■ Several days (1 point);

■ More than half the days (2 points);

■ Nearly every day (3 points).

The criterion and construct validity of the scale was assessed in 3,000 primary care patients. The main criticism of the tool relates to the fact that it is not very specific in regards to suicidal ideation.


Result interpretation

The overall PHQ-9 result ranges between 0 and 27. Patients scoring closer to 0 are less likely to exhibit symptoms associated with depression, whilst patients scoring closer to 27 are experiencing severe depressive symptoms.

The table below introduces the 4 severity stages and clinical recommendations:

Score Severity Recommendations
0 - 4 None No specific recommendations
5 - 9 Mild Monitoring symptoms
10 - 19 Moderate Referring for treatment
20 - 27 Severe Starting treatment and monitoring

The cut off values are at 5, 10 and 20 points. Scores above 10 are considered to indicate moderate to severe depression with 88% sensitivity and 88% specificity.


About the study

The PHQ 9 is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders.

This new measure of depression severity was constructed by Kroenke et al. in 2001 following a study on 6,000 patients, from 8 primary care clinics and 7 obstetrics-gynecology clinics.

Construct validity of the tool was tested via the 20-item Short-Form General Health Survey and information about self-reported sick days, clinic visits and symptom-related difficulty. Criterion validity was assessed in a sample of 580 patients via an independent structured mental health professional (MHP) interview.

High scores in the PHQ 9 were consistent with substantial decrease in functional status on the 6 scales of the SF-20.

The patient health questionnaire is a valid measure of depression severity.


Other types of patient health questionnaires

Primary care settings offer initial help with mental health disorders and then, if needed, the patient is referred to a specialist, either a psychologist or psychiatrist.

This is why, population should be advised to consider going to their GP, family doctor or personal practitioner if they experience signs of depression, if they feel low or lose interest in activities they used to enjoy.

These are some examples of questionnaires used in the initial diagnosis of depressive disorders or other mental health conditions:

■ PHQ 2, the short version of PHQ 9 which focuses on depression and loss of interest;

■ GAD 7, an evaluation of anxiety symptoms;

■ PHQ 15, an evaluation of somatisation and related symptoms;

■ PHQ – SADS, a combination form between the above models that screens overall presence of mental health disorders.


Original source

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13.


Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010; 8(4):348-53.

Other references

1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999; 282(18):1737-44.

2. Cameron IM, Crawford JR, Lawton K, Reid IC. Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract. 2008; 58(546):32-6.

Specialty: Psychiatry

System: Nervous

Objective: Evaluation

Type: Questionnaire

No. Of Items: 9

Year Of Study: 2001

Abbreviation: PHQ 9

Article By: Denise Nedea

Published On: July 16, 2017

Last Checked: July 16, 2017

Next Review: July 16, 2023