The PHQ-9 Depression Questionnaire: Scoring and What Your Score Means

The PHQ-9 is a one-page, nine-question depression questionnaire. You rate how often each symptom has bothered you over the last two weeks, from 0 (“not at all”) to 3 (“nearly every day”), and add the numbers. The total runs from 0 to 27: under 5 is minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe and 20 or more severe. That number describes how heavy your symptoms are right now. It is not a diagnosis. Below are the nine questions, a worked example, what each range usually leads to, and why the ninth question is handled differently from the rest.

What the PHQ-9 is, and who made it

The Patient Health Questionnaire-9 is the depression section of a larger tool called the PHQ, a self-completed version of an older clinician interview named PRIME-MD. Robert Spitzer, MD, Janet Williams, DSW, and Kurt Kroenke, MD, built it with colleagues at Columbia University and the Regenstrief Institute at Indiana University, supported by an educational grant from Pfizer. The validation paper appeared in the Journal of General Internal Medicine in 2001, after 6,000 patients in primary care and obstetrics-gynecology clinics completed it.

Two design choices explain why it is everywhere. Each of the nine questions matches one of the nine symptom criteria for major depression in the DSM, the diagnostic manual used in the United States, so it covers the ground a clinician would. And it is free. The official site, phqscreeners.com, states that no permission is required to reproduce, translate, display or distribute the PHQ screeners, which is why you will see it in doctors’ offices, hospital portals and apps. (You may read online that Pfizer created it in 2010; that is wrong. Pfizer funded the work, and the scale was published in 2001.)

The nine questions, one by one

Every question begins the same way: “Over the last 2 weeks, how often have you been bothered by any of the following problems?” The four answer choices are the same for all nine.

Answers are scored 0 for “not at all”, 1 for “several days”, 2 for “more than half the days” and 3 for “nearly every day”. A short tenth question follows: if you checked any problems, how difficult have they made it to work, take care of things at home or get along with people (not difficult at all, somewhat, very, or extremely difficult). That question is not added to the score. It records how much the symptoms are getting in the way, and clinicians read it alongside the total.

If question 7 is your highest item, our guide to the cognitive symptoms of depression explains why concentration and memory often slip with low mood.

How to score it, with a worked example

Scoring is simple addition. Add the nine numbers you circled; the tenth question is left out. Here is an illustrative example (not a real patient):

• Interest 2, mood 2, sleep 3, energy 3, appetite 1, self-worth 1, concentration 2, slowing or restlessness 0, question 9 0.
• Total: 2 + 2 + 3 + 3 + 1 + 1 + 2 + 0 + 0 = 14, the top of the moderate range.
• Difficulty question: “very difficult”. That tells a clinician the symptoms are already costing this person at work or at home.

The 2001 study found that the cutpoints 5, 10, 15 and 20 separated mild, moderate, moderately severe and severe depression. As scores climbed, people in the study reported worse day-to-day functioning, more sick days and more clinic visits, which is evidence that the number tracks something real in people’s lives.

*From the instruction manual on phqscreeners.com, which reproduces a table by Kroenke and Spitzer (2002). It was written to guide clinicians, not as a self-treatment plan. The same manual calls 10 or more a “yellow flag” worth attention and 15 or more a “red flag” where treatment is probably warranted.

Reading more than the total

Two people can both score 12 and be in very different places. Clinicians look at the pattern as well as the sum:

• The first two items. Low mood and loss of interest are the core of depression. Together they form the PHQ-2, a two-question screener in which 3 or more out of 6 prompts the full PHQ-9. A high total with zeros on both is a hint that something other than depression may be driving the score.
• How many items reach “more than half the days”. The original PHQ diagnostic rule needs at least five of the nine symptoms at that frequency, one of them mood or interest, before it suggests major depression. Question 9 counts if it is present at all, however often.
• Body-heavy scores. When most points come from sleep, energy and appetite, a clinician will think about thyroid function, anemia, sleep apnea, pregnancy or postpartum changes, and medication side effects. Our page on medical conditions that mimic mental illness covers the common ones.
• The difficulty question. A moderate score with “extremely difficult” can matter more than a higher score with “somewhat difficult”.

One score also reflects one fortnight, so the PHQ-9 is most informative when repeated over time. That use has its own rules; see how to tell whether your psychiatric medication is working for the tracking side.

Question 9: why it is treated differently

The last question asks about “thoughts that you would be better off dead or of hurting yourself in some way.” It is the one item where the frequency matters less than the fact that the thought is there at all. A “several days” answer here is worth more attention than a 3 on appetite.

Most people who mark it are describing passive thoughts, such as wishing they could disappear for a while, and never act on them. But the answer carries real information. In a 2013 study of more than 84,000 outpatients aged 13 and older, the one-year risk of a suicide attempt rose from about 0.4% in people who answered “not at all” to about 4% in those who answered “nearly every day”, even after accounting for overall depression severity. The extra risk built up over days and continued for months, so the authors described these thoughts as a lasting vulnerability rather than a one-time crisis.

The PHQ-9’s own instruction manual is clear that the score cannot settle the question: a final decision about the actual risk of self-harm requires a conversation with a clinician. In research studies that have no way to follow up, investigators sometimes use the PHQ-8, which is the same questionnaire with question 9 removed; that version exists for exactly this reason.

If question 9 applies to you, answer it honestly. The answer shapes how a clinician plans your care, not whether you get care.

What the PHQ-9 can’t tell you

• Whether it is bipolar depression. The questionnaire asks nothing about past periods of unusually high energy, little need for sleep or racing thoughts. That history changes treatment, which is why it is asked in an evaluation; see is it depression or bipolar disorder?.
• Whether it is grief, burnout or a medical problem. The PHQ terms of use note that a diagnosis also needs real impairment and ruling out normal bereavement, a history of mania, and a physical disorder, medication or drug as the cause.
• Anxiety, ADHD, trauma or substance use. Those need their own questions. The GAD-7 anxiety questionnaire is the PHQ-9’s companion for anxiety.
• Certainty either way. No screener catches everyone or clears everyone. How often the PHQ-9 misses or over-calls depression is covered in our guide to online mental health quizzes versus a real diagnosis.

Teens and the PHQ-9

The adult PHQ-9 has been studied in teenagers. In a 2010 study of 442 youth aged 13 to 17, a cutoff of 11 rather than 10 worked best, with similar accuracy to adults. A separate adolescent version, the PHQ-A, also exists. Note that Creyos labels its PHQ-9 for ages 18 and up. Parents of a teen who scores high should treat it the same way as for an adult: a reason for an evaluation, not a label. Our page on signs of depression in teens describes what to watch for.

Where you will meet the PHQ-9

You might be handed the PHQ-9 at a physical, a prenatal or postpartum visit, through a patient portal, or in a computerized assessment. Creyos, a platform that pairs computerized cognitive tasks with standard questionnaires, lists the PHQ-9 among the questionnaires clinicians can send. Our overview of the questionnaires in a Creyos assessment lists the rest, and the Creyos cognitive assessment guide explains the platform itself.

Clinicians who practice measurement-based psychiatric care repeat questionnaires like this one on a schedule so decisions rest on a trend, not on memory.

If your score has you worried, or if you scored low but still don’t feel like yourself, an evaluation is the next step. At Willow & Stone, Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, a board-certified psychiatric nurse practitioner, sees patients aged 10 and older for a 90-minute integrative psychiatric evaluation ($300) that looks at mood alongside sleep, health history and labs when useful. Bring your PHQ-9, including your answer to question 9. You can read more about how the practice approaches depression treatment, see pricing or book a consultation.

Common Questions

Sources & Further Reading

• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001 (PMC)
• PHQ Screeners — official site, downloads, licensing and instruction manual
• Simon GE et al. Does response on the PHQ-9 predict subsequent suicide attempt or suicide death? Psychiatr Serv, 2013 (PMC)
• Richardson LP et al. Evaluation of the PHQ-9 for detecting major depression among adolescents. Pediatrics, 2010 (PMC)
• Creyos — Standardized Questionnaires list (PDF)
• 988 Suicide & Crisis Lifeline

This article is general education, not a diagnosis or advice for your situation. Creyos results support, and never replace, a clinical evaluation; only a clinician who has evaluated you can diagnose a condition or recommend treatment. Do not start, stop, or change a medication without talking to the clinician who prescribes it.