Patient Health Questionnaire (PHQ-9)
Nine-item measure of depression severity, scored directly against the DSM criteria for a major depressive episode.
Last reviewed: May 2026
The PHQ-9 was developed by Kroenke, Spitzer and Williams (2001) as the depression module of the Patient Health Questionnaire. Its nine items map one-to-one onto the nine DSM criteria for a major depressive episode, asking how often each symptom has been present over the past two weeks, from low mood and loss of interest through sleep, appetite, concentration and thoughts of self-harm.
Scoring & Interpretation
Each of the nine items is rated 0 (not at all) to 3 (nearly every day) over the past two weeks. ClientForms sums the nine responses to a total of 0 to 27 and maps it to the five severity bands below. A score of 10 or above is the standard cut-off for clinically significant depression. A separate, unscored tenth question asks how difficult the symptoms have made daily functioning, which is recorded alongside the total rather than added to it.
| Score Range | Severity | Clinical Action |
|---|---|---|
| 0-4 | None-minimal | Minimal or no depressive symptoms: no action usually needed |
| 5-9 | Mild | Mild symptoms: watchful waiting, repeat at follow-up |
| 10-14 | Moderate | At or above the cut-off of 10: consider a treatment plan |
| 15-19 | Moderately severe | Active treatment with psychotherapy and/or medication |
| 20-27 | Severe | Prioritise treatment; review risk and consider specialist referral |
At the standard cut-off of 10 or above, the PHQ-9 has a sensitivity of 0.85 and specificity of 0.85 for major depression in a large individual-participant meta-analysis (Levis et al., BMJ 2019; 44 studies). Internal consistency is high (Cronbach's alpha 0.86 to 0.89) and test-retest reliability is strong (Kroenke et al., 2001). The severity bands at 5, 10, 15 and 20 index increasing symptom burden rather than mapping to fixed diagnoses.
When to Use This vs Alternatives
Use GAD-7 when…
Anxiety rather than low mood is the presenting concern, or you want to screen both. The PHQ-9 measures depression severity against the DSM criteria; the GAD-7 does the same for generalised anxiety, and the two are routinely administered together.
View GAD-7 →Use K-10 when…
You want a single index of overall psychological distress rather than a depression-specific severity score. The K-10 is the distress measure psychologists submit for Better Access in Australia; the PHQ-9 gives a depression-specific score that maps onto the diagnostic criteria.
View K-10 →Use DASS-21 when…
You want depression, anxiety and stress as three separate subscales from one form. The DASS-21 separates the components; the PHQ-9 gives a focused depression severity score that doubles as an outcome measure.
View DASS-21 →See It in Action
- 1Total depression score on the 0-to-27 scale with its severity band
- 2Score plotted against the five bands and the cut-off of 10
- 3Item 9 (thoughts of self-harm) flagged for review beside the total
- 4One-click PDF export and email delivery for the patient record
What It Measures
The PHQ-9 was developed by Kroenke, Spitzer and Williams (2001) as the depression module of the Patient Health Questionnaire. Its nine items map one-to-one onto the nine DSM criteria for a major depressive episode, asking how often each symptom has been present over the past two weeks, from low mood and loss of interest through sleep, appetite, concentration and thoughts of self-harm. It is the most widely used depression measure in primary care worldwide and doubles as a severity and outcome measure once depression is recognised.
When to Use the PHQ-9
Use the PHQ-9 to screen for depression, gauge its severity and track response to treatment over time. It is brief enough to repeat at each review, which makes it well suited to measurement-based care and to Better Access outcome reporting. It is a severity measure, not a diagnosis: a raised score indicates depressive symptoms that warrant clinical assessment, while the diagnosis and formulation remain the practitioner's judgement. Item 9 asks directly about thoughts of self-harm, so review any positive response to it regardless of the total.
Who It's For
Adults aged 18 and over, validated across primary-care, community and clinical samples internationally. Self-report: the patient completes it themselves. The PHQ-2 is the first two items, used as an ultra-brief first-step screen, and the Patient Health Questionnaire also includes an anxiety module (GAD-7). An adolescent version (PHQ-A) adapts the items for ages 12 to 18.
Frequently Asked Questions
What does the PHQ-9 measure?
The PHQ-9 is a nine-item self-report measure of depression severity over the past two weeks. Its items map directly onto the nine DSM criteria for a major depressive episode, giving both a screen and a severity score.
How is the PHQ-9 scored, and what is the cut-off?
Each item is rated 0 to 3 and the nine responses are summed to a total of 0 to 27. A score of 10 or above is the standard cut-off for clinically significant depression, with bands at 5, 10, 15 and 20.
What do the PHQ-9 severity bands mean?
A total of 0 to 4 indicates minimal symptoms, 5 to 9 mild, 10 to 14 moderate, 15 to 19 moderately severe and 20 to 27 severe depression. The bands suggest a level of severity; the clinical interpretation remains the practitioner's.
What does item 9 of the PHQ-9 assess?
Item 9 asks about thoughts of being better off dead or of self-harm. Any positive response warrants review regardless of the total score. ClientForms flags item 9 beside the total so it is not missed.
Is the PHQ-9 free to use?
Yes. The PHQ-9 is free to use, reproduce and translate without permission (Kroenke et al., 2001), which is one reason it is the most widely used depression measure in primary care.
How is the PHQ-9 used for measurement-based care?
The PHQ-9 is administered at intake and repeated at review to document change in depression severity. ClientForms scores it the moment the patient submits and produces a report you can attach to the treatment record.
Use the PHQ-9 in your practice
New accounts get 30 days of full Professional access, no card. After that it stays on the Free plan. Scored the moment patients submit.