Depression Test (PHQ-9 Screener)

The PHQ-9 is the criterion-standard 9-item depression screener used in primary care and behavioural health worldwide. PHQ-9 ≥10 = moderate depression (sensitivity 88%, specificity 88%). Score 0–27 across 5 severity levels. Kroenke, Spitzer & Williams (2001). Free to use.

Am I Depressed? What Depression Actually Feels Like

Depression (Major Depressive Disorder) is one of the most common and most disabling mental health conditions in the world. It is characterized by a persistent low mood or loss of interest or pleasure (anhedonia) in nearly all activities, lasting at least two weeks, representing a change from previous functioning. Unlike normal sadness, which is a temporary emotional response to life circumstances, clinical depression persists, causes significant impairment, and often occurs without an obvious external cause.

Depression presents differently in different people. Some experience overwhelming sadness; others describe feeling "empty," "numb," or "just going through the motions." Many report significant cognitive changes, difficulty concentrating, slowed thinking, indecisiveness, as well as physical changes such as disrupted sleep (insomnia or hypersomnia), appetite changes, and fatigue that doesn't improve with rest. Men more often present with irritability, anger, and risk-taking behaviour rather than overt sadness.

The most validated tool for depression screening and monitoring is the PHQ-9 (Patient Health Questionnaire-9), developed by Kroenke, Spitzer, and Williams (2001) and endorsed by major clinical guidelines including the USPSTF. A PHQ-9 score of 10 or above has sensitivity of 88% and specificity of 88% for major depression, meaning it accurately identifies most people with depression while rarely misidentifying those without it. The PHQ-9 is free to use; Pfizer states no permission is required to reproduce, translate, display or distribute it.

What the PHQ-9 measures

The PHQ-9 is the depression module of the Patient Health Questionnaire, a self-administered version of the PRIME-MD. It scores each of the nine DSM criteria for a major depressive episode from 0 (not at all) to 3 (nearly every day) over the past two weeks, giving a total from 0 to 27 that reflects depression severity.

DSM-5-TR MDD Criteria

The PHQ-9 items correspond directly to the nine symptom criteria for a major depressive episode as defined in the DSM-5-TR. A diagnosis of Major Depressive Disorder requires:

1. Five or more of the nine symptoms below to be present during the same two-week period, representing a change from previous functioning.
2. At least one of the five symptoms must be either (a) depressed mood or (b) loss of interest or pleasure (anhedonia).
3. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The episode is not attributable to the physiological effects of a substance or another medical condition.
5. The episode is not better explained by a psychotic disorder (e.g., schizoaffective disorder).

The nine DSM-5-TR criterion-A symptoms (which the PHQ-9 captures as a set):

The PHQ-9 was deliberately constructed to capture these nine criteria in a self-report format, making it one of the most theory-grounded screening tools in behavioural health. Note that the PHQ-9 item ordering differs from the DSM criterion ordering (e.g., the questionnaire leads with anhedonia, not depressed mood); the correspondence is at the level of the symptom set, not item-by-item position.

How to administer the PHQ-9

The PHQ-9 is a patient self-report questionnaire, completed by the person being screened; it takes approximately 2–3 minutes. A clinician may administer it verbally in some settings, but responses are based on the patient's own account of the past two weeks. In measurement-based care it is typically repeated at every clinical session or every 2–4 weeks during active treatment.

Rate how often you've been bothered by each of the following problems over the last 2 weeks. PHQ-9 is free to use.

PHQ-9 Item 9 (Suicidality)

PHQ-9 © Pfizer Inc. Free to use; no permission is required to reproduce, translate, display or distribute it. If you are experiencing suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline (call or text 988) promptly. This screener does not replace clinical evaluation.

PHQ-9 scoring and interpretation

Kroenke, Spitzer & Williams (2001). PHQ-9 ≥10 is the standard clinical cutoff. Scores should be interpreted alongside clinical context, longitudinal change, and functional impairment.

Score Interpretation

PHQ-9 scores map to five severity levels established in the original Kroenke, Spitzer, and Williams (2001) validation study across 6,000 primary care and obstetrics-gynecology patients:

Item 9 note: PHQ-9 Item 9 asks about thoughts of being better off dead or of hurting oneself. Any non-zero response — regardless of the total score — warrants direct clinical follow-up.

Psychometric properties

In the original validation, the PHQ-9 was completed by 6,000 patients in 8 primary care and 7 obstetrics-gynecology clinics. Against an independent structured mental health professional interview in 580 patients, a score of 10 or above had a sensitivity of 88% and a specificity of 88% for major depression, and higher scores tracked lower functional status and more sick days and clinic visits (Kroenke et al., 2001).

A 2019 individual participant data meta-analysis (Levis et al., BMJ; 58 studies, n = 17,357) found that a cutoff of ≥10 maximized combined sensitivity (0.88, 95% CI 0.83–0.92) and specificity (0.85, 95% CI 0.82–0.88) among studies using semistructured diagnostic interviews. A 2012 meta-analysis by Manea, Gilbody, and McMillan (CMAJ, n = 7,180) found acceptable diagnostic accuracy for cutoffs between 8 and 11; the evidence does not support a single universal cutoff, and clinicians should interpret scores in the context of functional impairment and clinical history.

Limitations

• Screening, not diagnosis. A positive screen (≥10) indicates that further clinical evaluation is warranted; diagnosis of major depressive disorder requires a comprehensive clinical interview, including ruling out medical causes and other conditions.
• Cutoff depends on context. Accuracy is acceptable across cutoffs of 8–11 (Manea et al., 2012), and the PHQ-9 may be less specific for younger than for older patients (Levis et al., 2019).
• Screens primarily for MDD. Other depressive disorders and common co-morbidities, particularly anxiety disorders, need separate consideration.
• Self-report. Scores depend on the patient's recall of the past two weeks and willingness to report symptoms, including item 9.

Types of depressive disorders

Depression is not a single condition. The DSM-5-TR recognizes several distinct depressive disorders, each with different onset patterns, durations, and clinical features:

• Major Depressive Disorder (MDD): One or more major depressive episodes, each lasting at least two weeks. The most common target of PHQ-9 screening. MDD is among the most prevalent mental health conditions globally.
• Persistent Depressive Disorder (dysthymia): Depressed mood present for most of the day, more days than not, for at least two years (one year in children/adolescents). Symptoms are typically less severe than MDD but are more chronic and can be equally disabling. A person can meet criteria for both MDD and persistent depressive disorder ("double depression").
• Disruptive Mood Dysregulation Disorder (DMDD): Diagnosed in children up to age 18; characterized by severe, recurrent temper outbursts and persistently irritable or angry mood most of the day.
• Premenstrual Dysphoric Disorder (PMDD): Marked mood lability, irritability, dysphoria, and anxiety symptoms that emerge in the final premenstrual week, improve within a few days of onset of menses, and become minimal in the week post-menses.
• Substance/Medication-Induced Depressive Disorder: A prominent and persistent depressed mood judged to be a direct result of intoxication, withdrawal, or medication exposure.
• Depressive Disorder Due to Another Medical Condition: Depressed mood directly caused by the physiological effects of a medical condition (e.g., hypothyroidism, Parkinson disease, stroke).
• Other Specified and Unspecified Depressive Disorders: Includes presentations that cause significant distress but do not meet full criteria for any of the above (e.g., recurrent brief depression, short-duration depressive episodes).

The PHQ-9 screens primarily for MDD. Clinicians should consider other depressive disorder diagnoses, and common co-morbidities (particularly anxiety disorders), when a patient screens positive.

Depression treatment and recovery

Depression has some of the highest treatment response rates of any mental health condition. Psychotherapy (CBT, Behavioural Activation, IPT, Problem-Solving Therapy) and antidepressant medication (SSRIs, SNRIs) each achieve response in approximately 50–60% of people with MDD; combining both increases response rates further. For treatment-resistant depression, augmentation strategies, ECT, and TMS have strong evidence. Recovery is achievable, and persistent effort to find the right approach is well supported by evidence.

Depression Outcome Monitoring in HiBoop

PHQ-9, GAD-7, and integrated mood outcome tracking, used by primary care, psychiatry, and behavioural health programs to monitor treatment response and care quality.