PHQ-9 (Patient Health Questionnaire-9)
Depression severity over the last 2 weeks
- NVL Unipolare Depression 2022
Sources last checked: 2026-10-13
PHQ-9 (Patient Health Questionnaire-9)
Depression severity over the last 2 weeks
Item 9 (thoughts of being better off dead or of self-harm) is a safety item: any answer above “Not at all” indicates thoughts of death or self-harm, whatever the total score, and is an indication for a direct clinical assessment of suicide risk on the same day. The PHQ-9 is a screening and severity measure, not a diagnosis.
Interpretation
| 0–4 — minimal | No or minimal depressive symptoms. Item 9 is interpreted on its own, independent of the total. |
|---|---|
| 5–9 — mild | Subthreshold to mild symptoms. |
| 10–14 — moderate | ≥ 10 detected major depression with 88 % sensitivity and 88 % specificity in the derivation study. The score is a screen; a diagnosis rests on a clinical interview. |
| 15–19 — moderately severe | Clinically relevant depression likely. |
| 20–27 — severe | Severe depressive symptom burden. |
What is the PHQ-9 (Patient Health Questionnaire-9)?
The PHQ-9 is the nine-item depression module of the Patient Health Questionnaire. Each item maps to one DSM criterion for major depression and is rated by frequency over the last two weeks (0–3). Kroenke, Spitzer and Williams validated it in 2001 in 6,000 primary-care and obstetrics-gynaecology patients, where a score of 10 or more identified major depression with 88 % sensitivity and specificity.
When to use it
- Case-finding in primary care or general hospital patients with possible depression
- Grading depression severity at baseline before treatment
- Monitoring response to antidepressants or psychotherapy over weeks
- As the second step after a positive PHQ-2
When not to use it
- As the sole basis for a diagnosis of depression — it is a screen and severity measure
- As a suicide-risk assessment — item 9 only flags who needs one
- In acute psychosis, delirium or severe cognitive impairment, where self-report is unreliable
How it is calculated
| Criterion | Points |
|---|---|
| 1. Little interest or pleasure in doing things | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 2. Feeling down, depressed, or hopeless | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 3. Trouble falling or staying asleep, or sleeping too much | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 4. Feeling tired or having little energy | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 5. Poor appetite or overeating | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 7. Trouble concentrating on things, such as reading the newspaper or watching television | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 8. Moving 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 | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 9. Thoughts that you would be better off dead, or of hurting yourself in some way | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
Clinical pearls and limitations
- Item 9 (thoughts of being better off dead or of self-harm) is a safety item: any answer above “Not at all” indicates thoughts of death or self-harm, whatever the total score, and is an indication for a direct clinical assessment of suicide risk on the same day. The PHQ-9 is a screening and severity measure, not a diagnosis.
- Item 9 is read on every form, independently of the total — a low total with a positive item 9 is still an indication for a same-day risk assessment.
- A drop of ≥ 5 points or a fall below 5 are common practical markers of response and remission.
- Somatic items (sleep, fatigue, appetite, concentration) can inflate scores in physically ill patients.
- The NVL Unipolare Depression lists the PHQ-9 with the same bands and notes that it is licence-free.
Frequently asked questions
What PHQ-9 score indicates depression?
A score of 10 or more is the usual cut-off for probable major depression. Scores of 5, 10, 15 and 20 mark mild, moderate, moderately severe and severe symptoms. The diagnosis itself needs a clinical interview.
What does a positive item 9 mean?
Any answer above “not at all” on item 9 indicates thoughts of death or self-harm, whatever the total score. It is an indication for asking directly about suicidal thoughts, plans, intent and protective factors on the same day.
Is the PHQ-9 free to use?
Yes. The PHQ instruments were developed with a grant from Pfizer and may be reproduced, translated, displayed and distributed without permission. Official translations, including German and Turkish, are available.
PHQ-9 or BDI?
The PHQ-9 is shorter, free and maps directly onto DSM criteria. The Beck Depression Inventory is copyrighted and licensed.
Evidence and guidelines
- Primary source: 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.
- NVL Unipolare Depression, Version 3.2 (2022), Anhang 1: Schwellenwerte bei psychometrischen Testverfahren — PHQ-9 bands; PHQ-9 is licence-free.
- PHQ Screeners (Pfizer) — official forms and translations, free to reproduce, translate, display and distribute.
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