QIDS-SR (Quick Inventory of Depressive Symptomatology)
QIDS-SR16: 16-item depression self-report, score 0–27. Covers all 9 DSM criteria. Domain-based scoring: sleep, mood, appetite, concentration. STAR*D trial.
QIDS-SR Score Interpreter
Score 6–10 indicates mild depression. Clinical monitoring, psychoeducation, and behavioural activation strategies are commonly indicated.
16 items mapped to 9 DSM symptom domains. Domain score = highest item within each group. Total = sum of 9 domain scores (range 0–27). Higher scores indicate greater depression severity.
| Total score | Interpretation |
|---|---|
| 21+ | Very Severe DepressionScore 21–27 indicates very severe depression. Urgent clinical evaluation and intensive treatment planning are warranted. |
| 16–20 | Severe DepressionScore 16–20 indicates severe depression. Prompt clinical review, pharmacotherapy and/or structured psychotherapy are typically required. |
| 11–15 | Moderate DepressionScore 11–15 indicates moderate depression. Active intervention — such as CBT, IPT, or pharmacotherapy — is recommended. |
| 6–10 | Mild DepressionScore 6–10 indicates mild depression. Clinical monitoring, psychoeducation, and behavioural activation strategies are commonly indicated. |
| 0–5 | Minimal / RemissionScore 0–5 indicates minimal or no depression. A score ≤5 is the standard QIDS-SR remission threshold used in STAR*D research (Trivedi et al., 2006). |
Rush AJ et al., Biol Psychiatry. 2003;54(5):573-583. Severity bands per established QIDS-SR clinical convention (0–5 none/remission, 6–10 mild, 11–15 moderate, 16–20 severe, 21–27 very severe). Remission threshold ≤5 per Trivedi MH et al., Am J Psychiatry. 2006;163(1):28-40. Educational reference only — not a diagnostic tool.
What is the QIDS-SR?
The Quick Inventory of Depressive Symptomatology: Self-Report (QIDS-SR16) was developed by John Rush, Madhukar Trivedi, and colleagues at the University of Texas Southwestern Medical Center (2003). It was designed to assess the full breadth of major depressive disorder as defined by DSM-IV, covering all nine symptom criteria with greater clinical granularity than shorter screening tools.
The QIDS-SR uses 16 items to assess 9 symptom domains: sleep disturbance (4 items), sad mood, appetite/weight changes (4 items), concentration, self-view, suicidal ideation, interest, energy/fatigue, and psychomotor changes (2 items). Within each domain, the highest item score is used. This domain scoring approach means the total ranges from 0 to 27 rather than a simple sum of all 16 items.
The QIDS-SR is free for clinical and research use with no copyright restrictions. It achieved particular prominence through its use in the STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression), the largest effectiveness trial ever conducted for major depression. It is commonly used alongside the PHQ-9 to provide a fuller picture of depressive severity.
Rate how you have felt over the past week. Answer all 16 items to see your domain score.
Domain 1: Sleep Disturbance (Items 1–4)
Answer only the sleep items that apply to you. If you sleep too little, answer items 1–3 and rate item 4 as 0. If you sleep too much, answer item 4 and rate items 1–3 as 0. Domain 1 score = highest rating among items 1–4.
1. Rate your difficulty falling asleep (initial insomnia): 0 = no difficulty; 1 = took longer than 30 minutes to fall asleep, less than half the time; 2 = took longer than 30 minutes to fall asleep, more than half the time; 3 = took more than 60 minutes to fall asleep, more than half the time.
2. Rate how often you woke during the night (middle insomnia): 0 = did not wake during the night; 1 = restless, light sleep with a few brief awakenings; 2 = woke up at least once a night but went back to sleep; 3 = awoke more than once and stayed awake for 20 minutes or more, more than half the time.
3. Rate early morning awakening: 0 = less than 1 hour before you need to get up; 1 = 1 hour or more before you need to get up, but went back to sleep; 2 = awoke 1 hour or more before you need to get up and could not go back to sleep; 3 = awoke more than 2 hours before you need to get up and could not go back to sleep.
4. Rate sleeping too much (hypersomnia): 0 = did not sleep too long; 1 = slept no more than 1 hour longer than needed; 2 = slept no more than 2 hours longer than needed; 3 = slept more than 2 hours longer than needed.
Domain 2: Sad Mood (Item 5)
5. Rate your depressed mood over the past week: 0 = did not feel sad; 1 = felt sad less than half the time; 2 = felt sad more than half the time; 3 = felt sad nearly all of the time.
Domain 3: Appetite / Weight Change (Items 6–9)
Answer both the appetite and the weight items that apply to you. Answer the other pair with 0 (no change). Domain 3 uses the highest score among items 6–9.
6. Rate decreased appetite: 0 = no change from usual; 1 = ate somewhat less often or smaller amounts than usual; 2 = ate much less than usual with deliberate effort; 3 = rarely ate within a 24-hour period, needed urging to eat.
7. Rate increased appetite: 0 = no change from usual; 1 = felt a need to eat more frequently than usual; 2 = regularly ate more often and/or greater amounts than usual; 3 = felt driven to overeat both at mealtime and between meals.
8. Rate weight loss in the past two weeks: 0 = not attempting to lose weight; 1 = feels as though some weight loss has occurred; 2 = has lost 2 pounds or more; 3 = has lost 5 pounds or more.
9. Rate weight gain in the past two weeks: 0 = not attempting to gain weight; 1 = feels as though some weight gain has occurred; 2 = has gained 2 pounds or more; 3 = has gained 5 pounds or more.
Domain 4: Concentration (Item 10)
10. Rate your ability to concentrate and make decisions: 0 = no change from usual; 1 = occasionally indecisive or attention wanders; 2 = struggled to focus or make decisions most of the time; 3 = unable to concentrate well enough to read or make minor decisions.
Domain 5: Self-View (Item 11)
11. Rate your view of yourself: 0 = see myself as equally worthwhile as others; 1 = more self-blaming than usual; 2 = largely believe I cause problems for others; 3 = think almost constantly about major and minor defects in myself.
Domain 6: Suicidal Ideation (Item 12)
If you are in crisis, contact the 988 Suicide & Crisis Lifeline by calling or texting 988: free, confidential, 24/7.
12. Rate thoughts of death or suicide: 0 = no thoughts of suicide or dying; 1 = feel that life is empty or wonder if it's worth living; 2 = think of suicide or death several times a week for several minutes; 3 = think of suicide or death several times a day in some detail, or have made a plan or attempt.
Domain 7: General Interest (Item 13)
13. Rate your general interest in people and activities: 0 = no change from usual; 1 = less interested than usual in other people or activities; 2 = interest in only one or two formerly pursued activities; 3 = virtually no interest in formerly pursued activities.
Domain 8: Energy / Fatigue (Item 14)
14. Rate your energy level: 0 = no change from usual; 1 = get tired more easily than usual; 2 = must make a significant effort to start or finish usual daily activities; 3 = unable to carry out most usual daily activities due to lack of energy.
Domain 9: Psychomotor Changes (Items 15–16)
Answer either the slowing or agitation items that best describe your experience. Domain 9 score = higher of items 15 and 16.
15. Rate psychomotor slowing (retardation): 0 = normal speed of thought, speech, and movement; 1 = slightly slower than usual; 2 = motor retardation or slower speech on much of the time; 3 = nearly unable to initiate tasks due to slowing; unable to speak without significant effort.
16. Rate psychomotor agitation: 0 = no agitation; 1 = fidgety; 2 = almost constant fidgeting, wringing of hands, and/or pulling of hair; 3 = unable to sit still, must keep moving or pacing.
QIDS-SR Score Interpretation
The following severity bands are a well-established QIDS-SR clinical convention. Total score = sum of the 9 domain scores (range 0–27). Domain score = highest item within each domain.
| Score | Severity | Common Clinical Implication |
|---|---|---|
| 0–5 | None / Remission | Below the clinical threshold; QIDS-SR remission in STAR*D defined as ≤5 |
| 6–10 | Mild | Psychoeducation, behavioural activation, and regular monitoring recommended |
| 11–15 | Moderate | Active treatment indicated (structured psychotherapy and/or pharmacotherapy) |
| 16–20 | Severe | Prompt clinical evaluation; combination treatment typically required |
| 21–27 | Very Severe | Urgent evaluation; intensive or specialized care warranted |
Educational reference only. Cannot diagnose or replace clinical evaluation.
How QIDS-SR Domain Scoring Works
Unlike the PHQ-9 (a simple sum), the QIDS-SR uses domain scoring: within each of the 9 DSM symptom domains, only the highest item score contributes to the total.
Domain 1: Sleep Disturbance
Items 1–4 assess four distinct sleep problems: trouble falling asleep (initial insomnia), waking in the night (middle insomnia), early morning waking (terminal insomnia), and sleeping too much (hypersomnia). Domain score = max(items 1–4).
Domain 2: Sad Mood
Item 5 alone: the core subjective depressed mood criterion. Rated 0 (not sad) to 3 (sad nearly all the time).
Domain 3: Appetite / Weight
Items 6–9 cover decreased appetite, increased appetite, weight loss, and weight gain. Only one direction is typically elevated. Domain score = max(items 6–9).
Domain 4: Concentration
Item 10 alone: difficulty focusing, making decisions, or remembering. 0 = no difficulty; 3 = cannot concentrate at all.
Domain 5: Self-View
Item 11: negative self-perception ranging from normal self-regard (0) to constant preoccupation with defects (3).
Domain 6: Suicidal Ideation
Item 12: ranges from no thoughts of death (0) to daily suicidal ideation (3). Any score >0 requires clinical follow-up.
Domain 7: General Interest
Item 13: anhedonia / loss of interest in usual activities. 0 = no change; 3 = no interest in anything previously enjoyed.
Domain 8: Energy / Fatigue
Item 14: physical energy depletion. 0 = no change; 3 = unable to carry out most activities due to fatigue.
Domain 9: Psychomotor Changes
Items 15–16 assess slowing and agitation. Take the higher of the two. Domain score = max(item 15, item 16).
Scoring Formula
Total QIDS-SR = D1 + D2 + D3 + D4 + D5 + D6 + D7 + D8 + D9
Where each Dn is the maximum item score within that domain. The maximum possible score is 3 × 9 = 27. The minimum is 0. This domain approach means that having both insomnia and hypersomnia does not double-count; only the more severe direction counts.
QIDS-SR vs PHQ-9
Both tools screen for major depression, but they differ in depth, scoring method, and clinical use case.
| Feature | QIDS-SR16 | PHQ-9 |
|---|---|---|
| Items | 16 | 9 |
| Domains | 9 (DSM criteria) | 9 (DSM criteria) |
| Sleep items | 4 (initial, middle, terminal, hypersomnia) | 1 |
| Appetite/weight items | 4 (both directions) | 1 |
| Scoring method | Domain scoring (max per group) | Simple sum |
| Score range | 0–27 | 0–27 |
| Remission threshold | ≤5 (STAR*D convention) | ≤4 (commonly used) |
| Response threshold | ≥50% reduction from baseline | ≥50% reduction from baseline |
| Primary use | Clinical research, treatment monitoring | Primary care screening |
| Administration time | 5–10 minutes | 3–5 minutes |
| Cost | Free, no copyright restrictions | Free, no copyright restrictions |
| Key validation study | Rush et al. (2003), STAR*D | Kroenke et al. (2001) |
The QIDS-SR's multi-item sleep and appetite domains make it more sensitive to changes in neurovegetative symptoms — the physiological features most responsive to pharmacotherapy. For rapid screening in primary care the PHQ-9 is the standard; for tracking treatment outcomes in specialty or research settings, the QIDS-SR is often preferred.
Track QIDS-SR Domain Scores Longitudinally in HiBoop
Automated domain scoring, trend visualization, and clinical documentation for every patient: QIDS-SR alongside PHQ-9 and MADRS.
Frequently Asked Questions
What is the QIDS-SR and how does it differ from the PHQ-9?
The QIDS-SR16 (Quick Inventory of Depressive Symptomatology: Self-Report) is a 16-item self-report depression scale developed by Rush, Trivedi, and colleagues (2003) at UT Southwestern. It covers all 9 DSM MDD symptom criteria with greater granularity than the PHQ-9: sleep disturbance is assessed with 4 items (versus 1 in the PHQ-9), and appetite/weight change is captured with 4 separate items for increase and decrease in each direction. The QIDS-SR uses domain scoring (the highest item within each group counts), yielding a 0–27 total. The PHQ-9 uses a simple 9-item sum over the same 0–27 range. The QIDS-SR is primarily used in clinical research and treatment monitoring; the PHQ-9 is the standard for rapid primary care screening.
How is the QIDS-SR scored?
The QIDS-SR16 uses domain scoring. The 16 items map to 9 symptom domains. Within each domain, only the highest-scoring item is counted: Domain 1 (Sleep) = max of items 1–4; Domain 2 (Sad Mood) = item 5; Domain 3 (Appetite/Weight) = max of items 6–9; Domain 4 (Concentration) = item 10; Domain 5 (Self-View) = item 11; Domain 6 (Suicidal Ideation) = item 12; Domain 7 (Interest) = item 13; Domain 8 (Energy) = item 14; Domain 9 (Psychomotor) = max of items 15–16. The total QIDS-SR score is the sum of all 9 domain scores, ranging from 0 to 27.
What does a QIDS-SR score of 11 or above mean?
A QIDS-SR total score of 11–15 indicates moderate depression. This band represents clinically significant symptom burden that warrants active intervention, typically structured psychotherapy (such as CBT or IPT), pharmacotherapy, or a combination. Scores of 16–20 indicate severe depression and scores of 21–27 indicate very severe depression, both of which require prompt clinical evaluation and more intensive treatment planning.
What are the 9 symptom domains the QIDS-SR assesses?
The QIDS-SR covers all 9 DSM-IV/DSM-5-TR criteria for major depressive disorder through the following domains: (1) Sleep disturbance: insomnia or hypersomnia; (2) Sad mood: depressed mood; (3) Appetite/weight change: decreased or increased appetite and corresponding weight change; (4) Concentration and decision-making; (5) Self-view: worthlessness and excessive guilt; (6) Suicidal ideation: thoughts of death or self-harm; (7) General interest: anhedonia or loss of interest; (8) Energy/fatigue: decreased energy or fatigability; (9) Psychomotor changes: retardation or agitation. This thorough coverage is a key advantage over shorter tools that assess each criterion with only a single item.
What is the QIDS-SR's role in the STAR*D trial?
The STARD trial (Sequenced Treatment Alternatives to Relieve Depression) was the largest effectiveness study of antidepressant treatment ever conducted, enrolling over 2,800 adults with non-psychotic major depression across primary care and psychiatric outpatient settings. The QIDS-SR was the primary self-report outcome measure used throughout STARD, allowing patients to track their own symptom trajectories between clinician visits. STAR*D defined remission as a QIDS-SR score ≤5 and treatment response as a ≥50% reduction from baseline (Trivedi et al., 2006). Its findings shaped contemporary understanding of treatment-resistant depression and the need for systematic measurement-based care.
Does HiBoop support the QIDS-SR?
Yes. HiBoop supports QIDS-SR16 digital administration with automated domain scoring: correctly applying the max-within-domain logic across all 9 criteria. Clinicians see the total score, individual domain scores, and severity band alongside longitudinal trend charts. The QIDS-SR can be tracked alongside the PHQ-9, MADRS, or any other depression measure in HiBoop's measurement-based care platform, supporting systematic treatment monitoring consistent with the STAR*D methodology.
References
- 1.Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R, Thase ME, Kocsis JH, Keller MB. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573-583.View source
- 2.Trivedi MH, Rush AJ, Ibrahim HM, Carmody TJ, Biggs MM, Suppes T, Crismon ML, Shores-Wilson K, Toprac MG, Dennehy EB, Witte B, Kashner TM. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med. 2004;34(1):73-82.View source
- 3.Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, Norquist G, Howland RH, Lebowitz B, McGrath PJ, Shores-Wilson K, Biggs MM, Balasubramani GK, Fava M; STAR*D Study Team. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163(1):28-40.View source
- 4.Doraiswamy PM, Bernstein IH, Rush AJ, Kyutoku Y, Carmody TJ, Macleod L, Venkatraman S, Burks M, Stegman D, Witte B, Trivedi MH. Diagnostic utility of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) in the elderly. Acta Psychiatr Scand. 2010;122(3):226-234.View source
Frequently Asked Questions
What is the QIDS-SR and how does it differ from the PHQ-9?
The QIDS-SR16 is a 16-item self-report depression scale that covers all 9 DSM major depressive disorder criteria, using domain scoring rather than a simple item sum. Sleep disturbance is assessed with 4 items and appetite/weight change with 4 items, giving greater granularity than the PHQ-9. Total scores range from 0 to 27. The PHQ-9 uses a 9-item sum over the same 0–27 range. The QIDS-SR is primarily used for clinical research and systematic treatment monitoring; the PHQ-9 is the standard for rapid primary care screening.
How is the QIDS-SR scored?
The 16 items map to 9 DSM symptom domains. Within each domain, only the highest-scoring item counts: Domain 1 (Sleep) = max of items 1–4; Domain 2 (Sad Mood) = item 5; Domain 3 (Appetite/Weight) = max of items 6–9; Domain 4 (Concentration) = item 10; Domain 5 (Self-View) = item 11; Domain 6 (Suicidal Ideation) = item 12; Domain 7 (Interest) = item 13; Domain 8 (Energy) = item 14; Domain 9 (Psychomotor) = max of items 15–16. The total is the sum of all 9 domain scores (range 0–27).
What QIDS-SR score indicates remission?
A QIDS-SR total score of 5 or below is the standard remission threshold used in STAR*D and subsequent depression research (Trivedi et al., 2006, Am J Psychiatry). Scores 6–10 indicate mild depression, 11–15 moderate, 16–20 severe, and 21–27 very severe. These severity bands are a well-established clinical convention; always interpret in the context of clinical judgement.
What are the 9 symptom domains the QIDS-SR assesses?
The QIDS-SR covers all 9 DSM-IV/DSM-5-TR criteria for major depressive disorder: (1) sleep disturbance (insomnia or hypersomnia); (2) sad/depressed mood; (3) appetite/weight change (decreased or increased in either direction); (4) concentration and decision-making; (5) self-view (worthlessness, guilt); (6) suicidal ideation; (7) general interest/anhedonia; (8) energy/fatigue; and (9) psychomotor changes (retardation or agitation).
What was the QIDS-SR's role in the STAR*D trial?
The STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression) was the largest effectiveness study of antidepressant treatment ever conducted, enrolling over 2,800 outpatients with non-psychotic major depression. The QIDS-SR was the primary self-report outcome measure throughout STAR*D, used to define remission (score ≤5) and response (≥50% reduction from baseline). Its integration into routine measurement-based care visits demonstrated that systematic outcome tracking is feasible and beneficial in both primary care and psychiatric settings (Trivedi et al., 2006).
Is the QIDS-SR free to use?
Yes. The QIDS-SR16 is free for clinical and research use with no copyright restrictions. It can be downloaded from the idsqids.org resource maintained by the University of Texas Southwestern Medical Center, which also provides the clinician-rated QIDS-C, the longer IDS-SR, and translations into multiple languages.
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