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.
Severity classification and treatment guidance
| Score | Severity | Suggested Action |
|---|---|---|
| 0-4 | None-minimal | Monitor. Watchful waiting. |
| 5-9 | Mild | Watchful waiting, repeat in 2-4 weeks. Consider guided self-help. |
| 10-14 | Moderate | Treatment plan. Consider counselling, CBT, and antidepressants. |
| 15-19 | Moderately severe | Active treatment with antidepressants and/or psychotherapy. Follow up closely. |
| 20-27 | Severe | Immediate 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.
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).