Instructions
Over the last 2 weeks, how often have you been bothered by any of the following problems? For each question, select the response that best describes how often you have been bothered by that problem.
1. Little interest or pleasure in doing things
Over the last 2 weeks, how often have you been bothered by having little interest or pleasure in doing things?
2. Feeling down, depressed, or hopeless
Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?
3. Trouble falling or staying asleep, or sleeping too much
Over the last 2 weeks, how often have you been bothered by trouble falling or staying asleep, or sleeping too much?
4. Feeling tired or having little energy
Over the last 2 weeks, how often have you been bothered by feeling tired or having little energy?
5. Poor appetite or overeating
Over the last 2 weeks, how often have you been bothered by poor appetite or overeating?
6. Feeling bad about yourself
Over the last 2 weeks, how often have you been bothered by feeling bad about yourself - or that you are a failure or have let yourself or your family down?
7. Trouble concentrating on things
Over the last 2 weeks, how often have you been bothered by trouble concentrating on things, such as reading the newspaper or watching television?
8. Moving or speaking slowly
Over the last 2 weeks, how often have you been bothered by moving or speaking slowly enough 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?
9. Thoughts of self-harm or being better off dead
Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?
PHQ-9 Score Interpretation
Clinical Management
- Minimal (0-4): Continue routine monitoring
- Mild (5-9): Consider watchful waiting, repeat assessment, or brief intervention
- Moderate (10-14): Consider treatment with psychotherapy and/or medication
- Moderately severe (15-19): Treatment with psychotherapy and/or medication recommended
- Severe (20-27): Immediate treatment recommended, consider psychiatric referral
- ⚠️ If question 9 (thoughts of self-harm) is scored ≥1, assess for suicide risk immediately
About PHQ-9
- Validated screening tool for depression severity
- Assesses symptoms over the past 2 weeks
- Each question scored 0-3 points
- Total score range: 0-27 points
- Question 9 specifically screens for suicidal ideation
- Can be used for initial screening and monitoring treatment response
PHQ-9 (Patient Health Questionnaire-9) Calculator
The Patient Health Questionnaire-9 (PHQ-9) is a validated, widely-used screening tool for depression severity. It consists of 9 questions that assess the frequency of depressive symptoms over the past 2 weeks, corresponding to the diagnostic criteria for major depressive disorder in the DSM-5.
PHQ-9 Questions and Scoring
The PHQ-9 assesses the following 9 symptoms of depression:
- Little interest or pleasure in doing things - Anhedonia
- Feeling down, depressed, or hopeless - Depressed mood
- Trouble falling or staying asleep, or sleeping too much - Sleep disturbance
- Feeling tired or having little energy - Fatigue
- Poor appetite or overeating - Appetite changes
- Feeling bad about yourself - Feelings of worthlessness
- Trouble concentrating on things - Concentration problems
- Moving or speaking slowly - Psychomotor changes
- Thoughts of self-harm or being better off dead - Suicidal ideation
Scoring System
Each question is scored on a 4-point scale:
- 0 points: Not at all
- 1 point: Several days
- 2 points: More than half the days
- 3 points: Nearly every day
Total score range: 0-27 points
Score Interpretation
Minimal Depression (0-4 points)
- Clinical significance: No significant depressive symptoms
- Prevalence: Normal mood state
- Management: Continue routine monitoring
- Follow-up: No specific intervention needed
- Treatment: Not indicated
Mild Depression (5-9 points)
- Clinical significance: Mild depressive symptoms
- Prevalence: Common in general population
- Management: Consider watchful waiting, repeat assessment, or brief intervention
- Follow-up: Reassess in 2-4 weeks
- Treatment: Consider brief psychotherapy or lifestyle interventions
Moderate Depression (10-14 points)
- Clinical significance: Moderate depressive symptoms
- Prevalence: Clinically significant depression
- Management: Consider treatment with psychotherapy and/or medication
- Follow-up: Monitor response to treatment
- Treatment: Psychotherapy and/or antidepressant medication
Moderately Severe Depression (15-19 points)
- Clinical significance: Moderately severe depressive symptoms
- Prevalence: Significant functional impairment
- Management: Treatment with psychotherapy and/or medication recommended
- Follow-up: Close monitoring of treatment response
- Treatment: Psychotherapy and antidepressant medication
Severe Depression (20-27 points)
- Clinical significance: Severe depressive symptoms
- Prevalence: Major functional impairment
- Management: Immediate treatment with psychotherapy and medication recommended
- Follow-up: Frequent monitoring, consider psychiatric referral
- Treatment: Psychotherapy, antidepressant medication, consider psychiatric consultation
Clinical Applications
Screening and Diagnosis
- Primary care screening: Routine depression screening in adults
- Diagnostic aid: Helps identify clinically significant depression
- Severity assessment: Quantifies depression severity
- Treatment planning: Guides treatment decisions based on severity
- Monitoring response: Tracks treatment effectiveness over time
Treatment Monitoring
- Baseline assessment: Establish pretreatment severity
- Response monitoring: Track symptom improvement
- Remission assessment: Determine when symptoms have resolved
- Relapse detection: Identify return of symptoms
- Treatment adjustment: Guide medication or therapy changes
Important Considerations
Suicide Risk Assessment
- Question 9: Specifically screens for suicidal ideation
- Any positive response: Requires immediate suicide risk assessment
- Clinical urgency: Higher scores indicate greater risk
- Safety planning: Develop safety plan for at-risk patients
- Referral: Consider psychiatric evaluation for high-risk patients
Limitations
- Self-reported symptoms may be unreliable
- Does not replace clinical judgment
- May not capture atypical presentations
- Cultural and language barriers may affect accuracy
- Requires patient literacy and comprehension
- May not distinguish between depression and other conditions
Special Populations
- Elderly patients: May have somatic symptoms predominating
- Adolescents: May require modified interpretation
- Pregnant/postpartum women: Consider perinatal depression screening
- Chronic medical conditions: Symptoms may overlap with medical illness
- Substance use disorders: May complicate interpretation
Clinical Pearls
- Always assess suicide risk if question 9 is scored ≥1
- Use clinical judgment in addition to PHQ-9 scores
- Consider cultural and social factors in interpretation
- Monitor for treatment response and side effects
- Address comorbid conditions that may affect depression
- Consider referral to mental health specialist for moderate-severe depression
- Document PHQ-9 scores in medical records for tracking
- Use in conjunction with other clinical assessments
Treatment Recommendations
Mild Depression (5-9 points)
- Watchful waiting with follow-up
- Brief psychotherapy (CBT, problem-solving therapy)
- Lifestyle modifications (exercise, sleep hygiene)
- Support groups or self-help resources
Moderate Depression (10-14 points)
- Psychotherapy (CBT, interpersonal therapy)
- Antidepressant medication
- Combined treatment approach
- Regular monitoring of response
Moderately Severe to Severe Depression (15-27 points)
- Antidepressant medication
- Psychotherapy
- Consider psychiatric consultation
- Close monitoring for safety
- Consider intensive treatment programs
This calculator provides a validated method for screening and monitoring depression severity, helping to guide appropriate treatment decisions and track patient progress over time. The PHQ-9 is widely used in clinical practice and has been validated in multiple populations and settings.
References
- Kroenke K, et al. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
- Kroenke K, et al. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-1292.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). 2013.
- Spitzer RL, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
- Gilbody S, et al. Screening and case finding instruments for depression. Cochrane Database Syst Rev. 2005;(4):CD002792.
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