PHQ-9 Depression Screening

The nine items of the PHQ-9 correspond directly to the nine symptoms of major depressive disorder from the DSM. Each item asks how often you've experienced that symptom in the past two weeks, scored 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27. The instrument was designed to be brief enough to fit into routine primary care visits while still capturing the full diagnostic symptom set. Importantly, the PHQ-9 measures CURRENT symptoms, not historical episodes — a person with prior depression who is currently well will score low; someone with new-onset depression will score high. The two-week window aligns with DSM diagnostic criteria for major depression.

Score thresholds map to severity bands with substantial clinical validation. 0–4 is minimal symptoms — typical of healthy adults. 5–9 is mild depression — significant but often manageable with lifestyle changes, watchful waiting, or brief counseling. 10–14 is moderate depression — generally warrants professional treatment, often with therapy, medication evaluation, or both. 15–19 is moderately severe — typically requires structured treatment. 20–27 is severe depression — usually warrants medication evaluation plus intensive therapy, sometimes including consideration of higher levels of care. The cutoff of 10 has 88% sensitivity and 88% specificity for major depressive disorder against structured clinical interviews. A score under 10 doesn't rule out depression entirely, especially if symptoms are highly disruptive; a score over 10 strongly suggests clinical evaluation.

Question 9 asks about thoughts of self-harm or being better off dead. ANY positive response on Q9 (a score of 1, 2, or 3) warrants immediate clinical attention regardless of the total PHQ-9 score. Suicidal ideation is a separate clinical concern from depression severity — a person can have a low total score but elevated Q9, and that combination still requires intervention. Clinical protocols mandate same-day or next-day clinical contact for any positive Q9. If you score positive on Q9, contact the 988 Suicide and Crisis Lifeline (call or text), go to an emergency room, or contact a mental health professional immediately. Mental health crises are medical emergencies and deserve immediate response.

The PHQ-9 is a screening tool, not a diagnostic instrument. Several conditions produce elevated PHQ-9 scores without major depression: bipolar disorder (depressive phase), grief reactions, certain medical conditions (hypothyroidism, anemia, chronic pain), substance use, side effects of medications, and acute stress reactions. A high score should prompt clinical evaluation, not self-diagnosis. The instrument also has known limitations in specific populations: post-partum women (PHQ-9 may underestimate severity), older adults (somatic symptoms overlap with normal aging), and adolescents (different version, PHQ-A, is preferred under age 18). Use the PHQ-9 alongside professional assessment, not as a replacement for it. If results concern you, talk to a healthcare provider.