Patient Health Questionnaire-9 (PHQ-9) - Mental Disorders Screening

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Patient Health Questionnaire-9 (PHQ-9) ShareThe PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.

Over the last 2 weeks, how often have you been bothered by the following problems?

Not at all

Several days

More than half the days

Nearly every day

1. Little interest or pleasure in doing things

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

2. Feeling down, depressed or hopeless

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

3. Trouble falling asleep, staying asleep, or sleeping too much

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

4. Feeling tired or having little energy

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

5. Poor appetite or overeating

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

6. Feeling bad about yourself - or that you’re a failure or have let yourself or your family down

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

7. Trouble concentrating on things, such as reading the newspaper or watching television

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

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

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

9. Thoughts that you would be better off dead or of hurting yourself in some way

Not at all0 Several days+1 More than half the days+2 Nearly every day+3

PHQ-9 score obtained by adding score for each question (total points)

Interpretation:

• Total scores of 5, 10, 15, and 20 represent cutpoints for mild, moderate, moderately severe and severe depression, respectively.
• Note: Question 9 is a single screening question on suicide risk. A patient who answers yes to question 9 needs further assessment for suicide risk by an individual who is competent to assess this risk.

Interpretation

Provisional Diagnosis and Proposed Treatment Actions

PHQ-9 Score	Depression Severity	Proposed Treatment Actions
0 – 4	None-minimal	None
5 – 9	Mild	Watchful waiting; repeat PHQ-9 at follow-up
10 – 14	Moderate	Treatment plan, considering counseling, follow-up and/or pharmacotherapy
15 – 19	Moderately Severe	Active treatment with pharmacotherapy and/or psychotherapy
20 – 27	Severe	Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management

Sources

• Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.
• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13.
• Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:509-21.

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