[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"assessment-depression-test":3,"all-assessments-nav":430,"related-assessments-query":1110},{"id":4,"title":5,"body":6,"category":361,"categoryTitle":362,"clinicalCitations":363,"copyright":361,"description":373,"disclaimer":361,"downloadLink":361,"extension":374,"faqs":375,"featured":388,"i18nReady":388,"icon":361,"interpreter":389,"lastReviewed":420,"meta":421,"navigation":422,"path":423,"permissionsNote":361,"published":388,"recommendedFrequency":361,"relatedCodes":361,"relatedConditions":361,"reviewedBy":361,"seo":424,"slug":425,"stem":426,"summary":427,"takeaways":361,"timeline":361,"type":428,"usedToDiagnose":361,"__hash__":429},"assessments\u002Fassessments\u002Fdepression-test.md","Depression Test (PHQ-9 Screener)",{"type":7,"value":8,"toc":347},"minimark",[9,13,18,21,24,27,31,34,37,40,44,47,52,55,133,136,143,147,150,186,189,275,278,282,285,330,333,337,340,344],[10,11,12],"p",{},"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 for clinical use.",[14,15,17],"h2",{"id":16},"am-i-depressed-what-depression-actually-feels-like","Am I Depressed? What Depression Actually Feels Like",[10,19,20],{},"Depression (Major Depressive Disorder) is one of the most common\nand most disabling mental health conditions in the world. It is characterized by\na persistent low mood or loss of interest or pleasure\n(anhedonia) in nearly all activities, lasting at least two weeks, representing a\nchange from previous functioning. Unlike normal sadness, which is a temporary\nemotional response to life circumstances, clinical depression persists, causes\nsignificant impairment, and often occurs without an obvious external cause.",[10,22,23],{},"Depression presents differently in different people. Some experience overwhelming\nsadness; others describe feeling \"empty,\" \"numb,\" or \"just going through\nthe motions.\" Many report significant cognitive changes, difficulty\nconcentrating, slowed thinking, indecisiveness, as well as physical changes\nsuch as disrupted sleep (insomnia or hypersomnia), appetite changes, and\nfatigue that doesn't improve with rest. Men more often present\nwith irritability, anger, and risk-taking behavior rather than overt sadness.",[10,25,26],{},"The most validated tool for depression screening and monitoring is the\nPHQ-9 (Patient Health Questionnaire-9), developed by Kroenke,\nSpitzer, and Williams (2001) and endorsed by major clinical guidelines including\nthe USPSTF. A PHQ-9 score of 10 or above has sensitivity of\n88% and specificity of 88% for major depression, meaning it accurately identifies\nmost people with depression while rarely misidentifying those without it. The\nPHQ-9 is free for clinical and research use.",[14,28,30],{"id":29},"phq-9-depression-screener","PHQ-9 Depression Screener",[10,32,33],{},"Rate how often you've been bothered by each of the following problems over the last 2 weeks. PHQ-9 is free for clinical and non-commercial use.",[10,35,36],{},"PHQ-9 Item 9 (Suicidality)",[10,38,39],{},"PHQ-9 © Pfizer Inc. Free for clinical and non-commercial research use. 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.",[14,41,43],{"id":42},"phq-9-score-reference","PHQ-9 Score Reference",[10,45,46],{},"Kroenke, Spitzer & Williams (2001). PHQ-9 ≥10 is the standard clinical cutoff. Scores should be interpreted alongside clinical context, longitudinal change, and functional impairment.",[48,49,51],"h3",{"id":50},"score-interpretation","Score Interpretation",[10,53,54],{},"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:",[56,57,58,74],"table",{},[59,60,61],"thead",{},[62,63,64,68,71],"tr",{},[65,66,67],"th",{},"Score",[65,69,70],{},"Severity Level",[65,72,73],{},"Suggested Action",[75,76,77,89,100,111,122],"tbody",{},[62,78,79,83,86],{},[80,81,82],"td",{},"0–4",[80,84,85],{},"Minimal or none",[80,87,88],{},"No action required; reassess if symptoms worsen",[62,90,91,94,97],{},[80,92,93],{},"5–9",[80,95,96],{},"Mild",[80,98,99],{},"Watchful waiting; repeat PHQ-9 in 2–4 weeks",[62,101,102,105,108],{},[80,103,104],{},"10–14",[80,106,107],{},"Moderate",[80,109,110],{},"Discuss treatment options; consider counselling or medication",[62,112,113,116,119],{},[80,114,115],{},"15–19",[80,117,118],{},"Moderately severe",[80,120,121],{},"Initiate treatment with antidepressant and\u002For psychotherapy",[62,123,124,127,130],{},[80,125,126],{},"20–27",[80,128,129],{},"Severe",[80,131,132],{},"Immediate treatment; consider urgent or specialist referral",[10,134,135],{},"The ≥10 threshold is the most widely used clinical cutoff. A 2019 individual participant data meta-analysis (Levis et al., BMJ, n = 17,357) confirmed that a cutoff of ≥10 maximizes combined sensitivity (0.88, 95% CI 0.83–0.92) and specificity (0.85, 95% CI 0.82–0.88) when compared against structured clinical 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.",[10,137,138,142],{},[139,140,141],"strong",{},"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.",[48,144,146],{"id":145},"dsm-5-tr-mdd-criteria","DSM-5-TR MDD Criteria",[10,148,149],{},"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:",[151,152,153,160,166,173,180],"ol",{},[154,155,156,159],"li",{},[139,157,158],{},"Five or more"," of the nine symptoms below to be present during the same two-week period, representing a change from previous functioning.",[154,161,162,165],{},[139,163,164],{},"At least one"," of the five symptoms must be either (a) depressed mood or (b) loss of interest or pleasure (anhedonia).",[154,167,168,169,172],{},"Symptoms cause ",[139,170,171],{},"clinically significant distress"," or impairment in social, occupational, or other important areas of functioning.",[154,174,175,176,179],{},"The episode is ",[139,177,178],{},"not attributable"," to the physiological effects of a substance or another medical condition.",[154,181,175,182,185],{},[139,183,184],{},"not better explained"," by a psychotic disorder (e.g., schizoaffective disorder).",[10,187,188],{},"The nine DSM-5-TR criterion-A symptoms (which the PHQ-9 captures as a set):",[56,190,191,201],{},[59,192,193],{},[62,194,195,198],{},[65,196,197],{},"DSM-5-TR Criterion",[65,199,200],{},"Symptom",[75,202,203,211,219,227,235,243,251,259,267],{},[62,204,205,208],{},[80,206,207],{},"A1",[80,209,210],{},"Depressed mood most of the day, nearly every day",[62,212,213,216],{},[80,214,215],{},"A2",[80,217,218],{},"Markedly diminished interest or pleasure in almost all activities (anhedonia)",[62,220,221,224],{},[80,222,223],{},"A3",[80,225,226],{},"Significant weight loss\u002Fgain or decrease\u002Fincrease in appetite",[62,228,229,232],{},[80,230,231],{},"A4",[80,233,234],{},"Insomnia or hypersomnia",[62,236,237,240],{},[80,238,239],{},"A5",[80,241,242],{},"Psychomotor agitation or retardation observable by others",[62,244,245,248],{},[80,246,247],{},"A6",[80,249,250],{},"Fatigue or loss of energy",[62,252,253,256],{},[80,254,255],{},"A7",[80,257,258],{},"Feelings of worthlessness or excessive or inappropriate guilt",[62,260,261,264],{},[80,262,263],{},"A8",[80,265,266],{},"Diminished ability to think, concentrate, or make decisions",[62,268,269,272],{},[80,270,271],{},"A9",[80,273,274],{},"Recurrent thoughts of death, suicidal ideation, or a suicide attempt",[10,276,277],{},"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 instruments in behavioural health. Note that the PHQ-9 item ordering differs from the DSM criterion ordering (e.g., the instrument leads with anhedonia, not depressed mood); the correspondence is at the level of the symptom set, not item-by-item position.",[48,279,281],{"id":280},"types-of-depressive-disorders","Types of Depressive Disorders",[10,283,284],{},"Depression is not a single condition. The DSM-5-TR recognizes several distinct depressive disorders, each with different onset patterns, durations, and clinical features:",[286,287,288,294,300,306,312,318,324],"ul",{},[154,289,290,293],{},[139,291,292],{},"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.",[154,295,296,299],{},[139,297,298],{},"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\u002Fadolescents). 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\").",[154,301,302,305],{},[139,303,304],{},"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.",[154,307,308,311],{},[139,309,310],{},"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.",[154,313,314,317],{},[139,315,316],{},"Substance\u002FMedication-Induced Depressive Disorder:"," A prominent and persistent depressed mood judged to be a direct result of intoxication, withdrawal, or medication exposure.",[154,319,320,323],{},[139,321,322],{},"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).",[154,325,326,329],{},[139,327,328],{},"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).",[10,331,332],{},"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.",[48,334,336],{"id":335},"depression-treatment-recovery","Depression Treatment & Recovery",[10,338,339],{},"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.",[14,341,343],{"id":342},"depression-outcome-monitoring-in-hiboop","Depression Outcome Monitoring in HiBoop",[10,345,346],{},"PHQ-9, PHQ-2, GAD-7, and integrated mood outcome tracking, used by primary care, psychiatry, and behavioural health programs to monitor treatment response and care quality.",{"title":348,"searchDepth":349,"depth":349,"links":350},"",3,[351,353,354,360],{"id":16,"depth":352,"text":17},2,{"id":29,"depth":352,"text":30},{"id":42,"depth":352,"text":43,"children":355},[356,357,358,359],{"id":50,"depth":349,"text":51},{"id":145,"depth":349,"text":146},{"id":280,"depth":349,"text":281},{"id":335,"depth":349,"text":336},{"id":342,"depth":352,"text":343},null,"Depression Screening",[364,367,370],{"text":365,"link":366},"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.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F11556941\u002F",{"text":368,"link":369},"Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F30967483\u002F",{"text":371,"link":372},"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):E191-6.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F22184363\u002F","Interactive PHQ-9 depression screener (0–27; ≥10 = moderate depression, sensitivity 88%). DSM-5-TR MDD criteria, 5 severity levels, depression types,...","md",[376,379,382,385],{"question":377,"answer":378},"What PHQ-9 score indicates depression?","A score of 10 or above is the standard clinical threshold. In the original validation study (Kroenke et al., 2001), a PHQ-9 ≥10 had sensitivity and specificity of 88% for major depressive disorder. Scores 10–14 indicate moderate depression, 15–19 moderately severe, and 20–27 severe. Any score should be interpreted alongside clinical context, not in isolation.",{"question":380,"answer":381},"Is the PHQ-9 self-report or clinician-administered?","The PHQ-9 is a patient self-report questionnaire — it is completed by the person being screened, not by a clinician. It takes approximately 2–3 minutes to complete. A clinician may administer it verbally in some settings, but the responses are based on the patient's own account of the past two weeks.",{"question":383,"answer":384},"Can the PHQ-9 diagnose depression?","No. The PHQ-9 is a screening and severity-monitoring tool, not a diagnostic instrument. A positive screen (score ≥10) indicates that further clinical evaluation is warranted. A diagnosis of major depressive disorder requires a comprehensive clinical interview, including ruling out medical causes and other conditions.",{"question":386,"answer":387},"How often should the PHQ-9 be repeated?","In measurement-based care, the PHQ-9 is typically repeated at every clinical session or every 2–4 weeks during active treatment. Tracking scores over time allows clinicians to assess treatment response and adjust care plans. A reduction of 5 or more points is considered a clinically meaningful change.",false,{"heading":390,"scaleLabel":391,"min":392,"max":393,"start":394,"note":395,"source":396,"bands":397},"PHQ-9 Score Interpreter","Total score",0,27,10,"9 items, each scored 0 (not at all) to 3 (nearly every day). Total score 0–27. Higher scores indicate greater symptom severity. Item 9 asks about thoughts of self-harm — any endorsement warrants immediate clinical follow-up regardless of total score.","Kroenke K et al. J Gen Intern Med. 2001;16:606-13. Severity ranges per Kroenke et al. (2001) validated severity thresholds. Educational reference only — not a diagnostic tool.",[398,403,407,411,416],{"min":399,"label":400,"level":401,"note":402},20,"Severe depression","error","Active treatment strongly indicated; urgent clinical evaluation recommended.",{"min":404,"label":405,"level":401,"note":406},15,"Moderately severe depression","Treatment typically indicated; comprehensive clinical evaluation needed.",{"min":394,"label":408,"level":409,"note":410},"Moderate depression","warning","Clinical threshold — evaluation and discussion of treatment options is appropriate.",{"min":412,"label":413,"level":414,"note":415},5,"Mild depression","info","Watchful waiting, psychoeducation, or low-intensity intervention may be appropriate.",{"min":392,"label":417,"level":418,"note":419},"Minimal or no depression","success","Scores below 5 suggest minimal depressive symptoms.","2026-06-03",{},true,"\u002Fassessments\u002Fdepression-test",{"title":5,"description":373},"depression-test","assessments\u002Fdepression-test","Interactive PHQ-9 depression screener (0–27; ≥10 = moderate depression, sensitivity 88%). DSM-5-TR MDD criteria, 5 severity levels, depression types, and treatment guide.","assessment","aittP5ZhsgvErozvhDkZzGoH3xoKEiUrbEKpvfrsJLI",[431,436,441,445,449,454,459,463,468,473,478,483,488,493,497,501,506,511,516,520,524,529,534,539,543,547,551,556,560,565,570,575,580,585,589,593,598,602,606,610,614,618,623,628,632,637,642,647,652,657,661,665,670,674,678,683,687,688,692,697,701,705,709,714,719,723,728,733,737,741,745,749,754,758,762,766,770,774,779,784,788,792,796,800,804,809,813,817,821,826,830,835,840,844,848,852,856,860,865,870,874,878,882,886,890,894,898,902,906,911,915,919,923,927,931,936,940,945,949,953,958,962,966,970,974,978,983,987,991,996,1000,1004,1008,1012,1016,1020,1024,1029,1034,1039,1044,1048,1052,1056,1060,1064,1068,1072,1076,1081,1085,1089,1093,1097,1101,1106],{"title":432,"slug":433,"path":434,"categoryTitle":435},"ACE Score","aces","\u002Fassessments\u002Faces","Trauma & PTSD",{"title":437,"slug":438,"path":439,"categoryTitle":440},"ADHD Clinical Outcome Scale, 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