Mental Health

PHQ-9 Depression Screening

The Patient Health Questionnaire-9 is the most widely validated depression screening tool in primary care. Score all 9 items based on the past 2 weeks and get instant severity classification with treatment guidance.

Kroenke et al. 2001 DSM-5 aligned PDF export
Clinical screening tool. The PHQ-9 is designed for clinical use by healthcare professionals to screen for depression. It is not a diagnostic test. Results should always be interpreted in clinical context. If you are in crisis, please contact a mental health professional or crisis service immediately.
PHQ-9, Over the past 2 weeks

How often have you been bothered by any of the following problems over the last 2 weeks?

PHQ-9 Result
⚠️ Item 9, Thoughts of self-harm or suicide detected
This patient endorsed item 9 (thoughts of being better off dead or self-harm). Clinical assessment of suicide risk is required. Do not leave this patient alone. Contact mental health services or emergency services if immediate risk is present.

Crisis resources: National Suicide Prevention Lifeline: 988 (US) | Samaritans: 116 123 (UK) | Crisis Text Line: Text HOME to 741741
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Severity bands:

0-4
None-Minimal
5-9
Mild
10-14
Moderate
15-19
Mod-Severe
20-27
Severe

About the PHQ-9

The Patient Health Questionnaire-9 was developed by Kroenke, Spitzer, and Williams (2001) and is licensed for free clinical use. It scores the 9 DSM criteria for major depressive disorder from 0 (not at all) to 3 (nearly every day), giving a maximum of 27 points. It's validated across primary care, hospital, and community settings, with the original validation study published in the Journal of General Internal Medicine.

Severity classification and treatment guidance

ScoreSeveritySuggested Action
0-4None-minimalMonitor. Watchful waiting.
5-9MildWatchful waiting, repeat in 2-4 weeks. Consider guided self-help.
10-14ModerateTreatment plan. Consider counselling, CBT, and antidepressants.
15-19Moderately severeActive treatment with antidepressants and/or psychotherapy. Follow up closely.
20-27SevereImmediate initiation of pharmacotherapy. Referral to mental health specialist.

Item 9 and suicide risk

Item 9 asks about thoughts of being better off dead or of hurting yourself. Any positive response requires direct clinical assessment. The PHQ-9 score itself doesn't predict suicide risk, it flags that a conversation must happen. Ask directly, assess lethality, and document your assessment.

PHQ-2 as an initial screen

The PHQ-2 uses only items 1 and 2 (anhedonia and depressed mood). A score of 3 or above on the PHQ-2 warrants full PHQ-9 assessment. Sensitivity 83%, specificity 92% for major depression at this cutoff.

Related tools

For anxiety screening, see GAD-7 Anxiety Scale. For occupational burnout, see Burnout Index. For sleep quality assessment, see Sleep Quality Score. For overall stress measurement, see Perceived Stress Scale. Depression and metabolic health are closely linked, patients with depression have elevated cardiovascular risk, so consider assessing 10-year cardiovascular risk with the Framingham Risk Score alongside mental health screening.

References

  • Kroenke K, Spitzer RL, Williams JBW. "The PHQ-9: validity of a brief depression severity measure." J Gen Intern Med. 2001;16(9):606-613.
  • NICE Guideline CG90. Depression in adults: recognition and management. NICE, 2009 (updated 2022).
Important: The PHQ-9 is a screening aid, not a diagnostic instrument. A positive screen does not mean depression is present; a negative screen does not rule it out. All results must be interpreted by a qualified clinician in the context of the full clinical picture.