PHQ-9 Depression Assessment
Instructions: Over the last 2 weeks, how often have you been bothered by the following problems? Select one response for each question.
Assessment Results
PHQ-9 Total Score
0
Minimal or No Depression
Minimal (0-4)
Mild (5-9)
Moderate (10-14)
Moderately Severe (15-19)
Severe (20-27)
Interpretation: Scores ≤4 suggest minimal depression which may not require treatment.
Management Guidelines
| Score Range | Severity | Action |
|---|
How to Use This Tool & About the PHQ-9
How to Use This Tool
- Read each question carefully with the patient
- Select responses for the past 2 weeks using the side-by-side buttons
- Results update automatically as you select answers
- The optional 10th question assesses global functional impairment but is not included in the total score
- Review the severity score and graphical presentation
- Check clinical recommendations based on the score
- Download PDF report for medical records
Note: This tool follows standard PHQ-9 scoring protocol (0-3 points per question, total 0-27).
About the PHQ-9
The Patient Health Questionnaire-9 (PHQ-9) is a validated, widely-used depression screening tool that assesses the presence and severity of depressive symptoms based on DSM-5 criteria.
Key Features:
- 9 items corresponding to DSM-5 depression criteria
- Scored from 0-3 per item (total 0-27)
- High sensitivity (88%) and specificity (88%)
- Validated across diverse populations
- Optional 10th question assesses functional impairment
- Tracks treatment response over time
Clinical Recommendations
For all scores: Final diagnosis should be made with clinical interview and mental status examination including assessment of patient's level of distress and functional impairment.
Based on Current Score (0):
- Monitor patient; may not require active treatment
- Patient does not report functional limitations due to symptoms
- Consider follow-up in routine care
Treatment Considerations
- Psychotherapy: CBT, interpersonal therapy, problem-solving therapy
- Pharmacotherapy: SSRIs, SNRIs, other antidepressants based on patient profile
- Combination: Psychotherapy + medications for moderate-severe depression
- Lifestyle: Exercise, sleep hygiene, social support, stress management
Monitoring & Follow-up
- Scores 5-9: Reassess in 2-4 weeks
- Scores 10-14: Consider treatment, follow up monthly
- Scores 15+: Active treatment, close monitoring (2-4 week intervals)
- All scores: Assess treatment response at 4-6 weeks
Critical Actions Required
Immediate Actions for All Patients:
- Suicide Risk Assessment: Perform immediately if patient responds positively to item 9 ("Thoughts that you would be better off dead or of hurting yourself")
- Rule Out Differential Diagnoses: Bipolar disorder, normal bereavement, medical disorders causing depression
- Assess Functional Impairment: Use the optional 10th question to assess impact on work, home, and social functioning
Safety Assessment
- Assess for suicidal ideation, intent, plan, and means
- Evaluate access to lethal means (firearms, medications)
- Identify protective factors and support systems
- Consider psychiatric consultation for high-risk patients
Functional Assessment
- The optional 10th question helps assess global functional impairment
- Consider work absenteeism, presenteeism, and productivity
- Evaluate impact on household responsibilities and self-care
- Assess social withdrawal and relationship difficulties
Frequently Asked Questions
What is the optional 10th question used for?
+
The optional 10th question assesses global functional impairment by asking how difficult depressive symptoms have made it to do work, take care of things at home, or get along with other people. While not included in the PHQ-9 total score, it provides valuable clinical information about the impact of symptoms on daily functioning.
How should I interpret a positive response to question 9?
+
A positive response to question 9 (suicidal ideation) requires immediate suicide risk assessment regardless of total score. This should include assessment of intent, plan, means, and protective factors. Consider psychiatric consultation or referral to emergency services if risk is present.
Why isn't the 10th question included in the total score?
+
The PHQ-9 standard scoring only includes the first 9 items which correspond directly to DSM-5 criteria for depression. The 10th question is an additional clinical tool to assess functional impairment, which is important for treatment planning but not part of the diagnostic criteria.
How often should the PHQ-9 be administered?
+
For screening: once during initial assessment. For monitoring: every 2-4 weeks during active treatment, then less frequently once stabilized. For remission monitoring: every 3-6 months during maintenance phase.
What are the limitations of the PHQ-9?
+
The PHQ-9 is a screening tool, not a diagnostic instrument. It may overestimate depression in medically ill patients, doesn't assess duration criteria for major depression, and requires clinical judgment for interpretation, especially in patients with comorbid conditions.
References and Sources
The following resources were used in developing this calculator and provide evidence-based guidelines for PHQ-9 use:
-
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure.
J Gen Intern Med. 2001;16(9):606-613.
- American Psychological Association. Clinical Practice Guideline for the Treatment of Depression.
-
Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the PHQ-9.
BMJ. 2012;344:d8201.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
- Official PHQ-9 Website with screening tools and validation studies.
- National Institute for Health and Care Excellence. Depression in adults: recognition and management.
Additional Reading:
- Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282(18):1737-1744.
- Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596-1602.
- 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.