Interactive Interpreter

Depression Test (PHQ-9 Screener)

The PHQ-9 (Patient Health Questionnaire-9) is a 9-item self-report questionnaire that screens for depression and rates its severity over the past 2 weeks, scored 0 to 27. A score of 10 or above is the standard cutoff for further evaluation (sensitivity and specificity 88% in the original study).

For professional reference, research, and education only. Not for diagnosis or medical advice.

PHQ-9 Score Interpreter

  • PHQ-9 Score Calculator

    Enter each of the 9 items (0–3) to total them; the range shows below. Items are numbered, not reproduced: enter them from the form in front of you.

    0 of 9 items entered — 9 still blank. The total can only rise, so treat the range as provisional.

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    Each item scores 0–3.

  • Enter a total score to see its range.

  • 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.

    Total scoreInterpretation
    20+Severe depressionActive treatment strongly indicated; urgent clinical evaluation recommended.
    15–19Moderately severe depressionTreatment typically indicated; comprehensive clinical evaluation needed.
    10–14Moderate depressionClinical threshold — evaluation and discussion of treatment options is appropriate.
    5–9Mild depressionWatchful waiting, psychoeducation, or low-intensity intervention may be appropriate.
    0–4Minimal or no depressionScores below 5 suggest minimal depressive symptoms.

    Kroenke K et al. J Gen Intern Med. 2001;16:606-13. Severity ranges per Kroenke et al. (2001) validated severity thresholds.

The PHQ-9 (Patient Health Questionnaire-9) is a 9-item depression screener used in primary care and behavioural health; the scale has its own page at PHQ-9. Totals run 0 to 27 across five severity levels, and 10 or above is the usual cutoff for further evaluation [1].

What is depression?

Depression (major depressive disorder) is characterized by a persistent low mood or loss of interest or pleasure (anhedonia) in nearly all activities, lasting at least two weeks and 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:

  • Cognitive changes: difficulty concentrating, slowed thinking, indecisiveness.
  • Physical changes: disrupted sleep (insomnia or hypersomnia), appetite changes, and fatigue that doesn't improve with rest.
  • Irritability: some people present with irritability, anger, and risk-taking behaviour rather than overt sadness.

The PHQ-9 was developed by Kroenke, Spitzer and Williams in primary care and obstetrics-gynecology clinics. In the original study, a score of 10 or above had a sensitivity of 88% and a specificity of 88% for major depression [1].

What does the PHQ-9 measure?

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 [1].

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):

DSM-5-TR CriterionSymptom
A1Depressed mood most of the day, nearly every day
A2Markedly diminished interest or pleasure in almost all activities (anhedonia)
A3Significant weight loss/gain or decrease/increase in appetite
A4Insomnia or hypersomnia
A5Psychomotor agitation or retardation observable by others
A6Fatigue or loss of energy
A7Feelings of worthlessness or excessive or inappropriate guilt
A8Diminished ability to think, concentrate, or make decisions
A9Recurrent thoughts of death, suicidal ideation, or a suicide attempt

The PHQ-9 was deliberately constructed to capture these nine criteria in a self-report format. 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 do you give the PHQ-9?

The PHQ-9 is a self-report questionnaire, completed by the person being screened. A clinician may read it aloud in some settings, but answers are based on the person'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.

The respondent rates how often they have been bothered by each problem over the last 2 weeks.

Item 9 (suicidality). 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.

How do you score and interpret the PHQ-9?

PHQ-9 ≥10 is the standard clinical cutoff [1]. 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 validation study across 6,000 primary care and obstetrics-gynecology participants [1]:

ScoreSeverity LevelSuggested Action
0–4Minimal or noneNo action required; reassess if symptoms worsen
5–9MildWatchful waiting; repeat PHQ-9 in 2–4 weeks
10–14ModerateDiscuss treatment options; consider counselling or medication
15–19Moderately severeInitiate treatment with antidepressant and/or psychotherapy
20–27SevereImmediate treatment; consider urgent or specialist referral

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

  • Original validation. The PHQ-9 was completed by 6,000 adults in 8 primary care and 7 obstetrics-gynecology clinics. Against an independent structured mental health professional interview in 580 participants, 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 [1].
  • Individual participant data meta-analysis (2019). Across 58 studies (n = 17,357), a cutoff of ≥10 maximized combined sensitivity and specificity. In the 29 studies (6,725 participants) that used semistructured diagnostic interviews, sensitivity was 0.88 (95% CI 0.83–0.92) and specificity 0.85 (95% CI 0.82–0.88) [2].
  • Cut-off meta-analysis (2012). Across 18 validation studies (n = 7,180), the PHQ-9 had acceptable diagnostic properties for cutoffs between 8 and 11 [3].

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 [3], and the PHQ-9 may be less specific for younger than for older adults [2].
  • Screens primarily for MDD. Other depressive disorders and common co-morbidities, particularly anxiety disorders, need separate consideration.
  • Self-report. Scores depend on the person'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.
  • 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 client screens positive.

Depression treatment and recovery

Depression is treatable. Options include psychotherapy (CBT, Behavioural Activation, IPT, Problem-Solving Therapy) and antidepressant medication (SSRIs, SNRIs), alone or combined.

For treatment-resistant depression, options include augmentation strategies, ECT, and TMS. Repeating the PHQ-9 during treatment shows whether the current approach is working.

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • What PHQ-9 score indicates depression?

    A score of 10 or above is the standard clinical threshold. In the original validation study, 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.

  • Is the PHQ-9 self-report or clinician-administered?

    The PHQ-9 is a self-report questionnaire: it is completed by the person being screened, not by a clinician. It is brief, with nine items. A clinician may read it aloud in some settings, but the answers are based on the person's own account of the past two weeks.

  • Can the PHQ-9 diagnose depression?

    No. The PHQ-9 is a screening and severity-monitoring tool, not a diagnostic tool. 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.

  • 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.

References

    1. 1.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.
    2. 2.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.
    3. 3.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.

    PHQ-9 © Pfizer Inc. No permission is required to reproduce, translate, display or distribute it.

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