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PHQ-9

Screens and measures severity of depression

PHQ-9

Screens and measures severity of depression

1: Little interest or pleasure in doing things
2: Feeling down, depressed, or hopeless
3: Trouble falling or staying asleep, or sleeping too much
4: Feeling tired or having little energy
5: Poor appetite or overeating
6: Feeling bad about yourself — or that you are a failure or have let yourself or your family down
7: Trouble concentrating on things, such as reading the newspaper or watching television
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
9: Thoughts that you would be better off dead or of hurting yourself in some way
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?
PHQ-9 0Minimal depression
0/10 answered · tap options to update (0–27)

Instructions

The PHQ is a self-reported questionnaire used to screen, diagnose, monitor, and measure the severity of depression. The most common version, the PHQ-9, includes 9 questions based on DSM criteria. Each item is scored from 0 (not at all) to 3 (nearly every day), giving a total score from 0 to 27.

Overview
When to use
Why use
Evidences

Interpretation

Score

Depression Severity

0–4

None or minimal

5–9

Mild

10–14

Moderate

15–19

Moderately severe

20–27

Severe

Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282(18):1737–1744. Introduced the Patient Health Questionnaire (PHQ), demonstrating feasibility and diagnostic validity for common mental disorders in primary care
https://pubmed.ncbi.nlm.nih.gov/10568646/

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. Established the 9-item depression module’s reliability, construct validity, and criterion validity; PHQ‑9 ≥10 had sensitivity 88% and specificity 88% for major depression
https://link.springer.com/article/10.1046/j.1525-1497.2001.016009606.x

Levis B et al. Accuracy of the PHQ‑9 for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476. Across 44 studies (N≈9,748), PHQ‑9 showed pooled sensitivity and specificity around 0.85 at cut-off 10; performance did not differ meaningfully by age or sex.
https://www.bmj.com/content/365/bmj.l1476

Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing major depression with the PHQ‑9: a meta-analysis. CMAJ. 2012;184(3):E191–E196. Supported cut-off 10 as a reasonable balance; highlighted setting-specific variation.
https://www.cmaj.ca/content/184/3/E191

Overview
When to use
Why use
Evidences

The Patient Health Questionnaire (PHQ) is a widely validated tool designed for primary care and mental health settings to identify and assess common psychiatric disorders. The PHQ-9 is the most frequently used form, focusing on the evaluation of depressive symptoms. It is derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD) and was developed to provide a brief, reliable, and practical measure that can be self-administered or clinician-administered.

The PHQ-9 aligns with the nine diagnostic criteria for major depressive disorder outlined in the DSM. It assesses the presence and severity of symptoms such as low mood, anhedonia, sleep changes, fatigue, appetite disturbance, feelings of guilt, concentration problems, psychomotor changes, and suicidal thoughts. Its brevity and ease of scoring make it particularly useful in routine care, allowing clinicians to quickly identify patients at risk and to track response to treatment over time.

Beyond depression, shorter versions like the PHQ-2 are used for initial screening, while extended versions such as the PHQ-15 cover somatic symptoms and the GAD-7 complements it for anxiety. In many settings, the PHQ is integrated into electronic health records, supporting systematic screening and measurement-based care.

Overview
When to use
Why use
Evidences

Interpretation

Score

Depression Severity

0–4

None or minimal

5–9

Mild

10–14

Moderate

15–19

Moderately severe

20–27

Severe

Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282(18):1737–1744. Introduced the Patient Health Questionnaire (PHQ), demonstrating feasibility and diagnostic validity for common mental disorders in primary care
https://pubmed.ncbi.nlm.nih.gov/10568646/

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. Established the 9-item depression module’s reliability, construct validity, and criterion validity; PHQ‑9 ≥10 had sensitivity 88% and specificity 88% for major depression
https://link.springer.com/article/10.1046/j.1525-1497.2001.016009606.x

Levis B et al. Accuracy of the PHQ‑9 for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476. Across 44 studies (N≈9,748), PHQ‑9 showed pooled sensitivity and specificity around 0.85 at cut-off 10; performance did not differ meaningfully by age or sex.
https://www.bmj.com/content/365/bmj.l1476

Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing major depression with the PHQ‑9: a meta-analysis. CMAJ. 2012;184(3):E191–E196. Supported cut-off 10 as a reasonable balance; highlighted setting-specific variation.
https://www.cmaj.ca/content/184/3/E191

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