Interpreting PHQ-9 Scores

This article explains the Patient Health Questionnaire 9-item (PHQ-9) screening tool. Learn what it is, how it helps assess depression, and how you can use the results to track symptoms, monitor progress, and guide treatment decisions.

Definition and purpose

The PHQ-9 is a 9-item self-report measure used to assess the frequency and severity of depression symptoms in clients 18 and older. The PHQ-A is a modified version for adolescents sent to clients 11-17 years old. Aligned with the DSM-V-TR criteria for Major Depressive Disorder (MDD) the results of these measures can support accurate diagnoses, the establishment of treatment goals based on symptom severity, and guide effective clinical interventions.

Items and scoring

Since your last visit, how often have you been bothered by the following problems?

  1. little interest or pleasure in doing things
  2. feeling down, depressed or hopeless
  3. trouble falling asleep or staying asleep or sleeping too much
  4. feeling tired or having little energy
  5. poor appetite or overeating
  6. feeling bad about yourself, that you are a failure or have let yourself or your family down
  7. difficulty concentrating
  8. moving or speaking slowly or being fidgety or restless
  9. thoughts you would be better off dead or of hurting yourself 

 

The client responds to each question via a Likert scale ranging from 0-3. 

0 = Not at all

1 = Several days

2 = More than half the days

3 = Nearly every day

 

Responses to all 9 questions are then summed to provide a total score of between 0-27.

A final prompt (not scored) is asked to assess the level of functional impairment as a result of any depressive symptoms.

 

If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people? 

  • Not difficult at all
  • Somewhat difficult
  • Very difficult
  • Extremely difficult

Interpreting scores

0 – 4 = None to minimal depression

5 – 9 = Mild depression

10 – 14 = Moderate depression

15 – 19 = Moderately severe depression

20 – 27 = Severe depression

 

Higher scores on the PHQ-9 indicate more severe depression, however, use clinical judgment to confirm a diagnosis. Consider if symptoms cause significant distress or impairment, as well as whether the symptoms are better explained by other conditions.

 

PHQ-9 clinical benchmarks border.png

 

For client safety, Rula automatically flags potential risk based on the client's responses. If a client answers affirmatively to thoughts of suicide or self-harm (Question #9), they'll see a real-time pop-up with the following information:

We are glad you are in care with us. Based on your survey responses, we’ve noticed you might need some additional support or resources. If you are experiencing a mental health crisis, please call or text 988 to be connected with the 24-hour Suicide and Crisis Helpline. If this is a life-threatening emergency, please call 911 or go to your nearest emergency room. Additional resources that might be helpful at this time can be found here.”

 

This screen offers immediate crisis support resources. However, management of each client's risk remains the responsibility of the therapist. If a client reports thoughts of self-harm or suicide, be sure to follow up, conduct a thorough risk assessment, and develop a safety plan

Monitoring

The PHQ-9 is a powerful tool to measure changes in symptomatology, track treatment progress, and inform treatment planning. It also has been associated with superior client outcomes when compared to usual care.


The PHQ-9 is publicly available: APA https://www.apa.org/depression-guideline/patient-health-questionnaire.pdf

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