The PHQ-9 score is calculated by adding up the point values of all nine questions, giving you a total between 0 and 27. Each question is scored from 0 to 3 based on how often the symptom occurred over the past two weeks: “not at all” equals 0, “several days” equals 1, “more than half the days” equals 2, and “nearly every day” equals 3.
The Point System for Each Question
The PHQ-9 asks about nine symptoms of depression, each mapped directly to the diagnostic criteria used by mental health professionals. The nine items cover: loss of interest or pleasure in activities, feeling down or hopeless, trouble sleeping (too much or too little), fatigue or low energy, poor appetite or overeating, feeling bad about yourself, trouble concentrating, moving or speaking noticeably slowly (or the opposite, feeling restless and fidgety), and thoughts of self-harm.
For every question, you select one of four responses:
- Not at all = 0 points
- Several days = 1 point
- More than half the days = 2 points
- Nearly every day = 3 points
Add up all nine values. That’s your total PHQ-9 score. The minimum is 0 (no symptoms at all) and the maximum is 27 (every symptom present nearly every day).
What to Do With Missing Answers
If one or two questions are left blank, you can still calculate a valid score. Take the average of the questions that were answered and substitute that average for the missing items. For example, if someone answered eight of nine questions and those eight totaled 12 points, the average per item is 1.5. Multiply 1.5 by 9 to get an estimated total of 13.5, which you’d round to 14. If more than two questions are unanswered, the questionnaire should be considered incomplete and the score isn’t reliable.
Score Ranges and Severity Levels
The American Psychiatric Association breaks the total score into five severity brackets:
- 0 to 4: No depression (minimal symptoms)
- 5 to 9: Mild depression
- 10 to 14: Moderate depression
- 15 to 19: Moderately severe depression
- 20 to 27: Severe depression
A score of 10 is the most commonly used threshold for flagging clinically significant depression. At that cutoff, the PHQ-9 correctly identifies 88% of people who do have major depression and correctly rules out 88% of people who don’t, based on validation research published in the Journal of General Internal Medicine. That balance of sensitivity and specificity is why 10 is the standard screening cutoff in most clinical settings.
How Scores Guide Next Steps
The score doesn’t diagnose depression on its own. It’s a screening tool that helps determine how much follow-up is appropriate. Scores below 10 generally call for monitoring, especially if symptoms are new or worsening. Scores in the 10 to 14 range typically prompt a conversation about a treatment plan, which might include counseling, medication, or both. For scores of 15 to 19, active treatment with therapy or medication is usually recommended. Scores of 20 or higher point toward starting treatment promptly, and if symptoms are severe or not improving, a referral to a mental health specialist.
These aren’t rigid rules. Each provider interprets the score alongside their clinical judgment and knowledge of the patient. A score of 8 in someone with a history of severe depressive episodes might warrant more attention than a score of 12 in someone dealing with a temporary stressor.
Why Question 9 Gets Special Attention
The ninth question asks about thoughts of self-harm or being “better off dead.” Any positive response on this item, even a score of 1 (“several days”), triggers additional follow-up regardless of the total score. A person could score a 5 overall but still need immediate support if they endorsed that item. Clinicians are trained to ask direct follow-up questions: whether the person has specific thoughts of harming themselves, and whether they have a plan. This is the one item on the PHQ-9 where the individual answer matters as much as the total.
Tracking Scores Over Time
One of the most useful features of the PHQ-9 is that it’s designed to be repeated. Because the questions ask about the past two weeks, retaking it at regular intervals (often monthly during treatment) creates a clear picture of whether symptoms are improving, stable, or getting worse. A drop of 5 or more points from one administration to the next is generally considered a meaningful improvement. Tracking the number over time gives both you and your provider concrete data instead of relying on memory of how you felt weeks ago.