PHQ-9 scoring, and a PHQ-8 mood check

How PHQ-9 scoring works

The PHQ-9 (Patient Health Questionnaire, nine items) was published in 2001 by Kurt Kroenke, Robert Spitzer and Janet Williams (Journal of General Internal Medicine, volume 16, pages 606 to 613). It grew out of PRIME-MD, a larger set of tools for spotting mental health conditions in primary care, and its nine questions follow the nine symptoms used to diagnose major depression. In the original study of 6,000 patients in primary care and obstetrics and gynecology clinics, a score of 10 or more picked up 88 percent of people with major depression, and 88 percent of people without it scored below 10.

Each question asks how often a problem has bothered you over the last two weeks, and each answer earns 0 to 3 points: "Not at all" 0, "Several days" 1, "More than half the days" 2, "Nearly every day" 3. Add the nine answers and the total runs from 0 to 27.

Level	PHQ-9 total	PHQ-8 total (this page)
None or minimal	0-4	0-4
Mild	5-9	5-9
Moderate	10-14	10-14
Moderately severe	15-19	15-19
Severe	20-27	20-24

PHQ-9 score interpretation

The cut-offs of 5, 10, 15 and 20 mark the bands Kroenke, Spitzer and Williams proposed in 2001, and they are used the same way today:

• 0 to 4: few or no depressive symptoms over the last two weeks.
• 5 to 9: mild symptoms. Often a case for keeping an eye on things and checking again in a few weeks, and for mentioning it to a doctor if it lasts or affects work or home.
• 10 to 14: moderate. A score of 10 or more is the usual point at which a clinician looks more closely.
• 15 to 19 and 20 to 27: moderately severe and severe. Both call for talking with a doctor or licensed mental health professional soon.

The total is not the only reading. Clinicians also look at the pattern: major depression is suggested when at least five items are answered "More than half the days" or more often, and one of them is item 1 (little interest or pleasure) or item 2 (feeling down, depressed or hopeless). Item 9 counts if it is answered at all. For tracking change over time, a drop or rise of 5 points or more is commonly treated as meaningful (Löwe and colleagues, Medical Care, 2004).

The paper form also ends with an unscored question about how difficult these problems have made work, home life and getting along with others. It is worth having an answer ready for any appointment.

Item 9 needs a clinician the same day

The ninth PHQ-9 question asks about thoughts that you would be better off dead, or of hurting yourself in some way. Any answer above "Not at all" calls for a conversation with a clinician the same day, whatever the total. Someone can score 6 overall and still have answered item 9 with "Several days". That is why a PHQ-9 total should never be read on its own.

If that question describes you right now, you do not have to wait for an appointment. Call or text 988 to reach the 988 Suicide and Crisis Lifeline, free and confidential, at any hour in the US. If you are in immediate danger, call 911.

Why this page runs the PHQ-8

A self-check on a website has no clinician watching the answers, so nobody could respond the same day to a positive answer on item 9. For that reason, the check on this page is the PHQ-8: the same first eight questions, with item 9 removed.

Kroenke and colleagues tested the PHQ-8 in 2009 (Journal of Affective Disorders, volume 114, pages 163 to 173) using data from nearly 200,000 adults in the CDC's Behavioral Risk Factor Surveillance System. Because thoughts of self-harm are relatively uncommon in the general population, dropping item 9 changes scores very little, and the same cut-offs apply. Your PHQ-8 score reads exactly like a PHQ-9 score on a 0 to 24 scale, with the top band running from 20 to 24.

Where the PHQ-2 fits

The PHQ-2 is the first two questions alone (little interest or pleasure, and feeling down, depressed or hopeless), scored 0 to 6. Kroenke, Spitzer and Williams described it in 2003 as a quick first pass, and a score of 3 or more usually leads to the full questionnaire. Many annual checkups start with it. Your first two answers on this page give you a PHQ-2 score too.

Limits

• The PHQ-9 and PHQ-8 are screening and reflection tools, not diagnoses. Tiredness, poor sleep, appetite changes and trouble concentrating also come with physical illness, pregnancy, a new baby, grief, some medications and heavy work strain. If your answers are mostly about exhaustion from work, the work burnout test looks at that side.
• They cannot tell depression in bipolar disorder from other depression. A doctor will ask about past periods of unusually high energy or mood.
• They cover two weeks and rely on self-report.
• The PHQ-8 says nothing about safety. If you have had thoughts of harming yourself, that matters more than any score.

Whatever your result, a doctor, a licensed counselor or your employee assistance program (EAP) can help you work out what is going on.

Frequently asked questions

What is a normal PHQ-9 score?

There is no single normal score, but 0 to 4 is the "none or minimal" range, and most people in general population surveys score below 5. Scoring 5 to 9 is common during a hard stretch and does not by itself mean depression.

What does a PHQ-9 score of 10 mean?

Ten is the start of the Moderate band and the cut-off most often used to identify current depression in studies. It is a good reason to book an appointment with your doctor or a licensed professional, who can confirm or rule out depression and talk through options.

Is a PHQ-8 score the same as a PHQ-9 score?

They read the same way. Both use the same bands, so a PHQ-8 score of 12 and a PHQ-9 score of 12 are both Moderate. The PHQ-8 tops out at 24 instead of 27 and leaves out the self-harm question.

Can my employer ask me to fill out a PHQ-9?

Employer-run depression screening is tightly limited in the US: it has to be voluntary and kept confidential, and individual results should not reach managers. The details are in what employers can and can't do with mental health screening.