PHQ-15: Patient Health Questionnaire Somatic Symptoms

Foundational Context

The PHQ-15 was developed by Kroenke, Spitzer, and Williams (2002) as the somatic symptom subscale of the Patient Health Questionnaire. It provides a brief, validated way to quantify the degree of distress caused by common physical complaints in primary care and behavioral health settings.

High somatic symptom burden is strongly associated with increased functional impairment, higher healthcare utilization, and co-occurring depression and anxiety.

What the Assessment Measures

The PHQ-15 evaluates the severity of 15 common somatic symptoms over the past 4 weeks:

• Stomach, back, and joint pain
• Headaches and chest pain
• Dizziness and fainting spells
• Heart pounding or racing
• Shortness of breath
• Bowel problems (constipation, diarrhea)
• Nausea and indigestion
• Fatigue and low energy
• Trouble sleeping
• Pain during intercourse (optional)
• Menstrual cramps (women only)

Items are rated 0 (Not bothered at all), 1 (Bothered a little), or 2 (Bothered a lot). Total score ranges from 0 to 30.

Interpretation Guidelines

• 0–4: Minimal somatic symptom severity.
• 5–9: Low severity.
• 10–14: Medium severity. Clinically significant burden; evaluate for somatic symptom disorder.
• 15–30: High severity. Substantial functional impairment; multidisciplinary care recommended.

Clinical Threshold: A score of 10 or higher warrants clinical evaluation of the physical symptoms and assessment for comorbid psychological distress.

Administration Considerations

• Time: 3–5 minutes.
• Format: Self-report.
• Menstrual Item: Applies only to women; handle consistently in scoring (often skipped or pro-rated for men).
• Integration: Best used alongside the PHQ-9 and GAD-7 to capture the full biopsychosocial picture.

Psychometric Properties

• Reliability: Strong internal consistency (α ≈ 0.80).
• Validity: Scores strongly predict disability days and health-related quality of life reductions.
• Sensitivity: Responsive to treatments for somatic symptom disorder and functional syndromes.

Limitations

• Does not distinguish between medically explained and medically unexplained symptoms.
• Chronic physical illness (e.g., fibromyalgia, cardiac disease) will naturally elevate scores.
• Not a diagnostic tool for Somatic Symptom Disorder (DSM-5-TR); requires clinician confirmation.

References

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: validity of a new measure for measuring somatic symptom severity. Psychosomatic Medicine, 64(2), 258-266.

Additional Context

The PHQ-15 is a 15-item validated measure of somatic symptom burden from the PHQ family. Scores 0–30 across four severity levels. Widely used alongside PHQ-9 for complete primary care screening.

What is the PHQ-15?

The PHQ-15 is the somatic symptoms subscale of the Patient Health Questionnaire (PHQ), developed by Kroenke, Spitzer, and Williams (2002). It assesses the presence and severity of 15 somatic symptoms over the past 4 weeks, covering common physical complaints including pain, fatigue, GI symptoms, and neurological symptoms.

Each item is rated on a 3-point scale: Not bothered at all (0), Bothered a little (1), Bothered a lot (2). The 15 items are drawn directly from the physical symptom checklist that generates the most common somatic complaints seen in primary care. Total scores range from 0 to 30 across four severity bands.

The PHQ-15 is part of the public domain PHQ scales developed at Pfizer and is free for clinical and research use. It is most commonly used alongside the PHQ-9 and GAD-7 to provide a complete picture of mental and physical health burden in primary care settings. High PHQ-15 scores (≥10) are associated with significantly greater functional impairment and healthcare utilization.

Rate how much each symptom bothered you over the last 4 weeks.

Educational reference only. Cannot diagnose or replace clinical evaluation.

PHQ-15 Severity Bands

Cutoffs from Kroenke, Spitzer & Williams (2002).

Complete PHQ Suite in HiBoop

PHQ-15, PHQ-9, PHQ-2, and GAD-7, all scored automatically and tracked longitudinally for every patient.