PHQ-9 Depression Questionnaire
The Patient Health Questionnaire-9 (PHQ-9), the nine-item self-report measure of depression severity over the past two weeks, reproduced in full with its scoring bands, interpretation notes and licence information.
About this resource
The PHQ-9 is the depression module of the Patient Health Questionnaire, developed by Kroenke, Spitzer and Williams from the PRIME-MD. Its nine items correspond to the nine DSM criteria for a major depressive episode, each rated for frequency over the past two weeks on a 0 to 3 scale, giving a total of 0 to 27. A tenth, unscored item asks how difficult the problems have made daily functioning. It takes most clients under three minutes to complete.
It is the most widely used depression measure in primary care and psychotherapy settings, and it serves two purposes: screening, where a total of 10 or more is the conventional threshold for further assessment, and severity monitoring, where the total is tracked across sessions. The original validation reported a sensitivity and specificity of 88% each for major depression at the threshold of 10, and a large individual participant data meta-analysis has since confirmed that 10 is a reasonable cut-off for screening in most settings.
The professional version adds the scoring table, notes on interpretation and clinical use, and guidance on the ninth item, which asks about thoughts of being better off dead or of self-harm and must be followed up whenever it is endorsed.
The instrument is reproduced here because Pfizer, the copyright holder, permits reproduction, translation, display and distribution of the PHQ family without permission. Item wording follows the published instrument, with the dashes in items 6 and 8 rendered as plain hyphens.
How to use it
- Administer at assessment and then at regular intervals, ideally every session or every other session, at the same point in each session.
- Score by summing items 1 to 9. The difficulty item is not added to the total; use it as a separate indicator of functional impact.
- Use the severity bands to describe the score to the client and to track change. A change of five points or more is commonly treated as clinically meaningful.
- Always check item 9 before the session moves on. Any response other than 'not at all' requires a direct conversation about suicidal thinking and a risk assessment appropriate to your setting.
- Treat a high score as a prompt for clinical assessment, not as a diagnosis. Consider bereavement, medical conditions, substance use and bipolar history before concluding that the picture is major depression.
References
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613.
- Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509-515.
- Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ, 365, l1476.
