The PHQ-9 is a nine-item depression screener used widely in primary care and psychiatry. Scores range from 0 to 27: 0 to 4 minimal depression, 5 to 9 mild, 10 to 14 moderate, 15 to 19 moderately severe, and 20 to 27 severe. A score of 10 or higher generally indicates that further clinical evaluation is appropriate. Question 9 specifically asks about suicidal thoughts and is followed up directly by clinicians. The PHQ-9 is a screening tool, not a diagnostic instrument; diagnosis is made by a clinician based on the full history.
The PHQ-9 is the depression equivalent of the GAD-7, and the two are typically used together in primary care. The PHQ-9 was developed by Kroenke, Spitzer, and Williams in 1999, validated extensively, translated into many languages, and is freely available in the public domain.
The nine questions
Over the last two weeks, how often have you been bothered by any of the following problems? Each item is rated 0 (not at all), 1 (several days), 2 (more than half the days), or 3 (nearly every day).
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself, or that you're a failure or have let yourself or your family down
- Trouble concentrating on things, such as reading the newspaper or watching television
- Moving or speaking so slowly that other people could have noticed; or the opposite, being so fidgety or restless that you've been moving around a lot more than usual
- Thoughts that you would be better off dead or of hurting yourself in some way
The nine items map closely to the DSM-5-TR criteria for major depressive disorder.
A tenth question is asked separately, not scored: "If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?" This functional impact question helps interpret the score.
What the score categories mean
| Score | Severity | Typical clinical response |
|---|---|---|
| 0 to 4 | Minimal | No treatment needed |
| 5 to 9 | Mild | Watchful waiting, repeat in 2 to 4 weeks |
| 10 to 14 | Moderate | Clinical evaluation; treatment usually warranted |
| 15 to 19 | Moderately severe | Active treatment with medication, therapy, or both |
| 20 to 27 | Severe | Active treatment, often combined; close follow-up; safety evaluation |
A score of 10 or higher is the most common threshold for considering treatment. The score doesn't establish a diagnosis; the clinician interprets it alongside the patient's history, symptom duration, functional impact, and the presence of co-occurring conditions. The PHQ-9 measures depression specifically; for the depression-focused interpretation of scores and follow-up, see DepressionResource.org.
The suicide item
Question 9 asks directly about suicidal thoughts. A positive response (any score above 0) typically triggers a follow-up conversation with the clinician, including:
- Whether the thoughts are passive (wishing not to wake up) or active (thoughts of doing something to cause harm)
- Whether there's a specific plan
- Whether there's intent to act
- Whether means are available
- Protective factors and reasons for living
- Past history of attempts
- Current support system
A positive PHQ-9 item 9 isn't by itself a reason for hospitalization. It's a reason for a careful clinical conversation that the patient and clinician have together. Many patients with depression have transient passive suicidal thoughts that don't require emergency intervention. Active suicidal ideation with plan or intent does require immediate evaluation.
If a patient is taking the PHQ-9 outside of a clinical setting and answers above 0 on item 9 with active thoughts of self-harm, the appropriate next step is to contact 988 (call or text in the United States) or to go to the nearest emergency department.
What the PHQ-9 is good for
Screening in primary care. The same use as the GAD-7. Brief, validated, easy to administer.
Tracking change over time. A patient on antidepressant treatment can take the PHQ-9 every 2 to 4 weeks to track progress. A score that drops from 18 to 8 over six weeks is meaningful response. A score that holds steady is a reason to adjust treatment.
Triage and treatment selection. A moderate score (10 to 14) might be approached with therapy alone or therapy plus medication. A severe score (20+) usually prompts combination treatment and closer follow-up. The treatments themselves, therapy, antidepressants, or both, are covered in how CBT and SSRIs actually work for anxiety, which applies in large part to depression as well.
Research and quality measurement. The PHQ-9 is one of the most-used outcome measures in mental health research. Many health systems use it as a quality metric.
What it isn't
The PHQ-9 isn't a diagnostic tool. A high score doesn't establish major depressive disorder; a low score doesn't rule out a depressive episode that doesn't fit the PHQ-9 questions well (such as atypical depression, melancholic depression with prominent somatic features, or depression with predominantly anxious features).
The PHQ-9 also doesn't distinguish depression from related conditions: bipolar disorder during a depressive episode looks similar on the PHQ-9; grief looks similar; medical conditions producing fatigue and low mood look similar. The clinical evaluation around the score is what sorts these apart.
Comparison with the GAD-7
The two are commonly used together because depression and anxiety co-occur so frequently. A patient with elevated scores on both is likely experiencing what the literature sometimes calls "mixed anxiety and depression" or "anxious depression," which has its own treatment considerations covered in the anxiety and depression overview.
External citations
The original PHQ-9 validation paper (Kroenke et al., 2001) is the canonical source. The PHQ screeners website hosts official versions of the PHQ-9 in many languages. The American Psychiatric Association practice guideline for depression discusses the PHQ-9 in measurement-based care.
Important note: This article is educational. It isn't a screening service. We don't host an interactive PHQ-9 because the tool is intended for use with a clinician who can interpret the score and address concerning answers. If you want to take the PHQ-9, see your primary care physician or a mental health clinician. If you're having thoughts of self-harm, call or text 988 in the United States.