The PHQ-9 is scored by adding up the point values for all nine questions, producing a total between 0 and 27. Each question is worth 0 to 3 points based on how frequently the person has experienced that symptom over the past two weeks. The higher the total, the more severe the depressive symptoms.
Point Values for Each Response
Every item on the PHQ-9 uses the same four-point scale:
- Not at all = 0 points
- Several days = 1 point
- More than half the days = 2 points
- Nearly every day = 3 points
Add the values from all nine questions together. That sum is the total severity score. If someone answered “several days” on three items, “more than half the days” on two items, and “not at all” on the remaining four, their score would be (3 × 1) + (2 × 2) + (4 × 0) = 7.
What the Total Score Means
The total maps to five severity levels, published by the American Psychiatric Association:
- 0 to 4: None to minimal depression
- 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 identifying clinically significant depression. Below that cutoff, symptoms are generally considered mild or minimal. At 10 or above, further evaluation and a treatment plan become appropriate.
Suggested Actions by Score Range
Each severity tier carries a different clinical implication. For scores of 0 to 4, no treatment for depression is typically needed. Scores of 5 to 9 usually call for watchful waiting, meaning the questionnaire is repeated at a later visit to see if symptoms have worsened, stayed the same, or improved.
At 10 to 14, a treatment plan comes into play. That could mean counseling, medication, or both, depending on how long the symptoms have lasted and how much they interfere with daily life. Scores of 15 to 19 point toward active treatment with therapy, medication, or a combination. At 20 to 27, the recommendation is to start treatment promptly and, if symptoms are causing serious impairment, to involve a mental health specialist.
The Tenth Question Is Scored Separately
The PHQ-9 actually has a tenth item that asks how difficult these problems have made it to do work, take care of things at home, or get along with other people. This question is not added into the 0-to-27 total. Instead, it serves as a check on functional impairment. For a provisional depression diagnosis, the person’s answer on this question should be at least “somewhat difficult.” If someone scores high on the nine symptom items but reports no difficulty functioning, that context matters for interpretation.
Why Question 9 Needs Extra Attention
The ninth item asks about thoughts of being better off dead or of hurting yourself. Any non-zero response on this question, even “several days,” warrants a deeper conversation about suicide risk regardless of the total score. The PHQ-9 is a screening tool, not a diagnostic instrument on its own, and this item in particular flags something that requires follow-up assessment by someone trained to evaluate safety.
Handling Missing Answers
If one or two items are left blank, you can calculate a prorated score: add the completed items, divide by the number of items answered, then multiply by nine. For example, if eight items are completed and total 12 points, the prorated score would be (12 ÷ 8) × 9 = 13.5, rounded to 14. If three or more items are unanswered, the total score should not be used because too much information is missing for a reliable result.
Scoring for Adolescents (Ages 11 to 17)
A modified version called the PHQ-A uses the same nine items, the same 0-to-3 point scale, and the same severity thresholds (0 to 4 for none, 5 to 9 for mild, and so on up to 20 to 27 for severe). The scoring process is identical. The only difference is that the language of some questions is adapted to be more appropriate for younger respondents. The same rule about missing items applies: if three or more are blank, the score is not valid.
Putting the Score in Context
The PHQ-9 measures symptom severity over the previous two weeks. A single score is a snapshot, not a diagnosis. Scores can fluctuate based on life circumstances, sleep, or even the time of year. Clinicians often administer it repeatedly over time to track whether someone is improving or getting worse, which makes consistent scoring especially important. A drop of five or more points between administrations is generally considered a meaningful improvement.
Because each of the nine items maps to one of the core diagnostic criteria for major depressive disorder, the PHQ-9 also gives a quick picture of which specific symptoms are most prominent. Looking at individual item scores, not just the total, helps identify whether the main problems are sleep-related, energy-related, concentration-related, or something else entirely.