The PHQ-9 (Patient Health Questionnaire-9) is a nine-question screening tool used to detect and measure the severity of depression. Scores range from 0 to 27, with a score of 10 or higher generally indicating depression that may need treatment. It’s one of the most widely used mental health questionnaires in primary care, and you’ve likely encountered it on a clipboard or tablet screen before a routine appointment.
The tool isn’t a diagnosis on its own. It’s a starting point that helps your provider decide whether to explore further, monitor your symptoms over time, or connect you with treatment.
What the Nine Questions Ask
Each question on the PHQ-9 maps directly to one of the nine symptoms used to diagnose major depressive disorder. You’re asked how often, over the past two weeks, you’ve been bothered by each of the following:
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself, or that you’re a failure or have let your family down
- Trouble concentrating on things like reading or watching television
- Moving or speaking noticeably slowly, or the opposite: being unusually fidgety or restless
- Thoughts that you would be better off dead or of hurting yourself
For each question, you choose one of four responses: “not at all” (0 points), “several days” (1 point), “more than half the days” (2 points), or “nearly every day” (3 points). The whole thing takes just a few minutes to complete. You can fill it out yourself on paper or a screen, or a staff member can read the questions to you. Self-administered versions tend to produce slightly higher scores than interviewer-led ones, likely because people feel more comfortable being honest on paper than face-to-face.
How Scoring Works
Your total score falls into one of five severity categories:
- 0 to 4: Minimal or no depression
- 5 to 9: Mild depression
- 10 to 14: Moderate depression
- 15 to 19: Moderately severe depression
- 20 to 27: Severe depression
The key threshold is 10. At that cutoff, the PHQ-9 correctly identifies about 85% of people who have major depression and correctly rules it out in about 85% of people who don’t. That’s strong accuracy for a screening tool this brief.
What Your Score Means in Practice
A score in the minimal range (0 to 4) generally requires no follow-up. If you land in the mild range (5 to 9), your provider will typically take a “watchful waiting” approach, meaning they’ll check in again at a future visit and repeat the questionnaire to see if symptoms have shifted.
Moderate scores (10 to 14) usually prompt a conversation about a treatment plan, which might include counseling, closer follow-up, or medication. In the moderately severe range (15 to 19), active treatment with therapy, medication, or both becomes the standard recommendation. Severe scores (20 to 27) call for prompt treatment and, if symptoms are significantly impairing daily life or not improving, a referral to a mental health specialist.
These are guidelines, not rigid rules. Your provider will weigh your score alongside your history, life circumstances, and how you’re functioning day to day before deciding on next steps.
Why Question 9 Gets Special Attention
The final question, about thoughts of being better off dead or hurting yourself, is handled differently from the rest. Any positive answer to this question, even “several days,” triggers a separate assessment for suicide risk. This happens regardless of your total score. So even if someone scores low overall, a yes on question 9 means their provider will ask more detailed follow-up questions to understand the nature and urgency of those thoughts.
How the PHQ-9 Is Used Beyond a Single Visit
The PHQ-9 isn’t just a one-time screening. One of its most practical uses is tracking depression over time. If you start therapy or medication, your provider may have you complete the questionnaire at regular intervals to see whether your score is trending downward. A drop of 5 or more points is generally considered a meaningful improvement. This gives both you and your provider an objective way to gauge whether treatment is working, rather than relying solely on a general sense of “feeling better” or “about the same.”
The U.S. Preventive Services Task Force recommends depression screening for all adults, including pregnant and postpartum individuals and older adults. There’s no firm guideline on how often to screen, but the general approach is to screen everyone at least once, then use clinical judgment to decide who benefits from repeat screening based on risk factors and life events. A positive screen is never the final word. It always leads to a more thorough evaluation to confirm a diagnosis, assess severity, and check for other conditions that might look like depression or exist alongside it.
What the PHQ-9 Doesn’t Do
The PHQ-9 screens for depression specifically. It does not assess anxiety, bipolar disorder, PTSD, or other mental health conditions, though separate questionnaires exist for those. It also can’t distinguish between depression caused by a life event, a medical condition, or a chemical imbalance. That distinction requires a clinical conversation.
Because it relies on self-reporting, the PHQ-9 is only as accurate as your answers. Rushing through it, minimizing symptoms, or filling it out on an unusually good or bad day can all skew the result. If you’re completing one, it’s worth pausing on each question and thinking honestly about the full two-week window it asks about, not just how you feel in the waiting room that morning.