PHQ-9 Depression Screening Test

The PHQ-9 is the depression module of the Patient Health Questionnaire. Its nine items map directly onto the nine diagnostic criteria for major depressive disorder, which is what makes it unusual among brief screeners: the same instrument both flags a possible problem and tracks how it changes over time.

It was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. It is free to reproduce, translate, display and distribute without permission, which is why it turns up in nearly every primary-care clinic, health system and research study that screens for depression.

Each of the nine items is answered on the same frequency scale and scored 0 to 3: not at all is 0, several days is 1, more than half the days is 2, and nearly every day is 3. Add the nine answers together for a total between 0 and 27.

The first two items on their own form the PHQ-2, a two-question ultra-brief screen scored 0 to 6. A PHQ-2 of 3 or more is the usual trigger to ask the remaining seven questions, which is why many clinics ask two questions first and nine only if needed.

The bands describe symptom load, not a label. A score of 12 means you reported a moderate amount of symptom burden over two weeks; it does not mean you have moderate depression as a diagnosis. Clinicians read the number alongside two other things: which items are elevated, and how much the symptoms interfere with work, home life and relationships.

That second question is asked as an unscored tenth item on the paper version — how difficult these problems have made it to do your work, take care of things at home, or get along with other people. If your answer would be “very difficult” or “extremely difficult”, that matters as much as the total.

A score of 10 or more is the cut-point most often used to prompt further evaluation, and around that threshold the questionnaire correctly identifies roughly 88% of people with major depression while correctly clearing roughly 88% of those without it. A change of 5 points is generally taken as a meaningful shift when the same person is retested.

Question 9 asks about thoughts that you would be better off dead or of hurting yourself in some way. If you answer anything other than “Not at all”, this page shows crisis-line details as the first thing in your result — above the score, and whether the total lands in the severe band or the minimal one. Thoughts of self-harm are not something a low total explains away.

Clinicians treat this item the same way: a non-zero answer prompts a same-day conversation about safety, independent of the severity band. Telling someone is the step that matters — a clinician, a crisis line, or a person you trust who can stay with you while you make the call.

As a screener it performs well: at a cut-point of 10 it has been validated across thousands of primary-care and obstetric patients, and it works about as well when self-administered as when a clinician reads the questions aloud. As a diagnostic instrument it was never designed to stand alone, and it has predictable blind spots:

• Physical illness inflates it. Fatigue, poor sleep and appetite change are symptoms of anaemia, thyroid disease, sleep apnoea, chronic pain and many medications as much as of depression.
• It cannot tell unipolar depression from the depressed phase of bipolar disorder, which needs different treatment — a history of manic or hypomanic episodes changes the picture entirely.
• It measures two weeks. Grief, a recent loss, or an acute crisis can produce a high score that reflects circumstance rather than a disorder.
• It says nothing about cause, and nothing about what would help. Two people with identical scores can need completely different things.

This is why every guideline that recommends screening also requires that a positive screen be followed by a proper assessment rather than by immediate treatment.

1. 1.If question 9 was above “Not at all”, talk to someone today — 988 by call or text, or HOME to 741741.
2. 2.Save or screenshot your answers. Which items are elevated is more useful to a clinician than the total alone.
3. 3.For a score of 10 or more, book with a primary-care clinician or a mental health professional and bring the result.
4. 4.For 5 to 9, retake it in two weeks. A stable mild score and a rising one call for different responses.
5. 5.Rule out the ordinary explanations alongside: thyroid function, iron levels, sleep, alcohol, and any medication started recently.

Depression is one of the most treatable conditions in medicine, and the treatments — talking therapy, medication, or both — work for most people who complete them. The gap that costs people years is between noticing and telling somebody, not between treatments.