Calculators / Depression and mood

PHQ-9

Patient Health Questionnaire-9. Depression screening and severity.

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The PHQ-9 calculator is in the Library.

Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.

Use it for

  • Screening adults for depression in primary care, psychiatry and other medical settings.
  • Rating the severity of depressive symptoms at baseline.
  • Tracking response to treatment, using the same scale at every visit.
  • Starting a conversation about mood and about thoughts of self-harm (item 9).

Do not use it for

  • Making the diagnosis on its own. A positive screen needs a clinical interview.
  • Estimating suicide risk. Item 9 prompts a direct risk assessment and nothing more.
  • Telling unipolar from bipolar depression.
  • Children under 12, or adults with significant cognitive impairment (see the GDS-15 for older adults).

Ask the person to answer for the last 2 weeks. Choose one answer for each of the nine items. The last question, about difficulty, is not part of the score.

1Little interest or pleasure in doing things
2Feeling down, depressed, or hopeless
3Trouble falling or staying asleep, or sleeping too much
4Feeling tired or having little energy
5Poor appetite or overeating
6Feeling bad about yourself, or that you are a failure or have let yourself or your family down
7Trouble concentrating on things, such as reading the newspaper or watching television
8Moving 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
9Thoughts 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?Optional. This item is not added to the total.

PHQ-9

Answer the questions to see the result.

This calculator adds up the score in your browser. Nothing you enter is stored or sent.

More about the PHQ-9

About the PHQ-9What it is and what it is for

The PHQ-9 turns the nine DSM-IV criteria for a major depressive episode into a short questionnaire. Each item asks how often a symptom has bothered the person over the past two weeks, from not at all (0) to nearly every day (3). The total runs from 0 to 27.

It does two jobs. It screens for depression in primary care and other medical settings, and it tracks severity over the course of treatment. It was built for those jobs and works best when used for them.

How to use itGiving it and scoring it

Give the questionnaire on paper, on a screen or aloud. Ask for the last two weeks. Check that no items are blank before scoring.

Score each answer from 0 to 3 and add the nine items for a total from 0 to 27. This page does that for you. The question about difficulty is not part of the total.

Interpreting the scoreScore ranges and what they suggest
ScoreWhat it suggestsUsual response
0 to 4Minimal or noneFew or no depressive symptoms in the past two weeks.No treatment from the score alone. Rescreen if the picture changes.
5 to 9MildSome symptoms. May or may not meet criteria for a depressive disorder.Watchful waiting with a repeat PHQ-9 at follow-up. Offer behavioral or lifestyle support.
10 to 14ModerateThe usual screening cutoff for probable major depression.Confirm with an interview, then make a treatment plan: psychotherapy, medication, or both, with follow-up.
15 to 19Moderately severeSubstantial symptoms and usually impairment.Active treatment with psychotherapy, medication, or both.
20 to 27SevereMarked symptom burden.Start treatment promptly. Refer for specialty care if impairment is severe or response is poor.

Bands are from Kroenke, Spitzer and Williams (2001). The treatment column follows the authors' original proposals for each severity level and is a starting point for a clinical decision, not a protocol.

Pearls and pitfallsTips and common mistakes
  • A total of 10 or more is the usual positive screen. Some programs use 8 or 9 to catch more cases at the cost of more false positives.
  • Look at item 9 and at items 1 and 2 first. The authors' algorithm needs item 1 or item 2 to be present at "more than half the days".
  • Use the same version, with the same wording and time frame, at every visit, so scores can be compared.
  • For ages 12 to 17 use the PHQ-9 modified for adolescents (PHQ-A). In pregnancy and the postpartum year the Edinburgh Postnatal Depression Scale was built for the purpose.
  • Medical illness, pain and sleep disorders raise the somatic items. Consider reading the total alongside items 1, 2 and 6.
  • Do not skip the risk conversation because the total is low. Do not start it from the total alone either. Start it from item 9 and from your own read of the person.
EvidenceAccuracy and reliability
  • Development sample (Kroenke 2001, about 6,000 patients in primary care and obstetrics-gynecology clinics): a score of 10 or more had 88% sensitivity and 88% specificity for major depression on a structured interview. Internal consistency was high (alpha 0.86 to 0.89) and test-retest reliability was 0.84 over 48 hours.
  • A later individual-participant-data meta-analysis (Levis 2019) found sensitivity and specificity in the mid-80s percent at a cutoff of 10, and similar accuracy across cutoffs of 8 to 11.
  • Minimal clinically important difference: about 5 points (Löwe 2004).
  • Item 9 responses predict later suicide attempts and suicide deaths in a graded way, with higher risk at higher response levels. Most people who later attempt or die do not endorse the item at the most recent screen, so it is a prompt and not a prediction (Simon 2013).
Source, license and referencesWhere it comes from

The PHQ-9 was developed by Drs. Robert L. Spitzer, Janet B. W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. The authors state that no permission is required to reproduce, translate, display or distribute it. Item wording on this page is the published wording, with punctuation adjusted.

  1. 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.
  2. Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.
  3. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care. 2004;42(12):1194-1201.
  4. Simon GE, Rutter CM, Peterson D, et al. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv. 2013;64(12):1195-1202.
  5. US Preventive Services Task Force. Screening for depression and suicide risk in adults. JAMA. 2023;329(23):2057-2067.
  6. National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). 2022.

Clinical decision support, not a diagnosis. Each calculator scores a published scale the way its authors intended. A score informs a clinical interview and examination and never replaces them. If you are a patient using this page, please review the result with your clinician. In an emergency, call 911 or call or text 988 in the United States.