PHQ-9 — Patient Health Questionnaire

The Patient Health Questionnaire-9 (PHQ-9) is a widely used, brief self-report measure designed to evaluate the presence and severity of depressive symptoms.

Questions: 9
Duration: 3 min
Original title: PHQ-9 — Patient Health Questionnaire
Adaptation: PHQ-9 — Patient Health Questionnaire
Authors: Kroenke, K., Spitzer, R.L. & Williams, J.B.W.
Created: 2001

The Patient Health Questionnaire-9 (PHQ-9) is a widely used, brief self-report measure designed to evaluate the presence and severity of depressive symptoms. Originally developed for primary care settings, it has become a gold standard across mental health and medical contexts for its brevity and strong psychometric properties. It provides clinicians with a standardized way to track how patients are feeling and functioning over a two-week period.

Because it aligns directly with the core diagnostic criteria for major depressive disorder, the PHQ-9 serves as an excellent foundational assessment. Incorporating this validated measure into routine care allows clinicians to establish a clear baseline at intake, objectively measure treatment response over time, and adjust interventions when progress plateaus. If scores remain elevated, this data might prompt a provider to build a longitudinal case formulation to understand predisposing factors, or to shift treatment focus toward fostering psychological flexibility in depressed patients.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

12/ 27

The PHQ-9 is a 9-item self-report questionnaire derived from the DSM-IV diagnostic criteria for major depressive disorder. It enables screening, severity assessment, and monitoring of depressive symptoms in adults, in both primary care and specialized care settings. The total score, ranging from 0 to 27, indicates five severity levels (minimal, mild, moderate, moderately severe, severe). Item 9 assesses suicidal ideation or self-harm and requires a clinical assessment of suicide risk when scored ≥ 1.

0–4

Minimal depression

5–9

Mild depression

10–14

Moderate depression

15–19

Moderately severe depression

20–27

Severe depression

Severity level demarcating moderate depression

clinicalmixed · pathology: major depressive disorder · ≥ 18 years · United States · n = 41 · Kroenke et al. (2001)

027

M = 17.1 ± 6.1

clinicalmixed · pathology: other depressive disorder · ≥ 18 years · United States · n = 65 · Kroenke et al. (2001)

027

M = 10.4 ± 5.4

clinicalmixed · pathology: no depressive disorder · ≥ 18 years · United States · n = 474 · Kroenke et al. (2001)

027

M = 3.3 ± 3.8

Scoring

Sum, total score from 0 to 27, each item is scored on a 4-point scale (from 0 to 3).

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What the test measures

The PHQ-9 measures the severity of depressive symptoms based on the core diagnostic criteria of a major depressive episode.

Anhedonia: Loss of interest or pleasure in daily activities.
Mood: Pervasive feelings of sadness, low affect, or hopelessness.
Vegetative symptoms: Meaningful changes in sleep patterns, appetite, and energy levels.
Cognitive symptoms: Difficulties with concentration and negative self-evaluations, which often manifest as highly critical automatic thoughts.
Psychomotor shift: Observable physical slowing down or internal restlessness and agitation.
Suicidality: Passive or active thoughts of death or self-harm.

This instrument is appropriate for adults and adolescents presenting with potential mood disturbances in primary or specialty clinical settings.

When and why to use it

Clinicians use the PHQ-9 at multiple stages of the therapeutic process to bring objective measurement to mood tracking.

Intake baseline: Establishes initial symptom severity before beginning psychotherapy or pharmacological treatment.
Routine monitoring: Tracks the trajectory of change session-by-session to see if an intervention like an activity menu is genuinely reducing symptoms.
Screening: Highlights subtle functional impacts or unvoiced distress that may warrant taking time to explicitly open the depression conversation in session.
Risk evaluation: Flagging the final item provides a standardized prompt to explore suicidality safely and directly.

Adding a validated PHQ-9 score over general clinical impression grounds treatment decisions in objective, repeatable data.

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The questions

Over the last 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things
Assesses the presence of anhedonia, a core diagnostic feature of depression.
- Not at all
- Several days
- More than half the days
- Nearly every day
2. Feeling down, depressed, or hopeless
Evaluates the subjective experience of low mood or depressive affect.
- Not at all
- Several days
- More than half the days
- Nearly every day
3. Trouble falling or staying asleep, or sleeping too much
Identifies sleep disturbances, including both insomnia and hypersomnia.
- Not at all
- Several days
- More than half the days
- Nearly every day
4. Feeling tired or having little energy
Probes for fatigue and loss of energy, common physical manifestations of low mood.
- Not at all
- Several days
- More than half the days
- Nearly every day
5. Poor appetite or overeating
Checks for significant changes in appetite and eating behaviors.
- Not at all
- Several days
- More than half the days
- Nearly every day
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down
Examines cognitive symptoms like guilt, worthlessness, and negative self-appraisal.
- Not at all
- Several days
- More than half the days
- Nearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television
Assesses cognitive impairments affecting focus and daily functioning.
- Not at all
- Several days
- More than half the days
- Nearly every day
8. Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
Evaluates the presence of observable psychomotor retardation or agitation.
- Not at all
- Several days
- More than half the days
- Nearly every day
9. Thoughts that you would be better off dead, or of hurting yourself in some way
Screens for passive death wishes or active thoughts of self-harm, requiring immediate safety evaluation.
- Not at all
- Several days
- More than half the days
- Nearly every day