PHQ-9 Depression

What is PHQ-9

The Patient Health Questionnaire 9 (PHQ-9) is the depression scale from Patient Health Questionnaire (PHQ). It is used for assessing and monitoring depression severity. Recognizing signs of mental health disorders is not always easy. The Patient Health Questionnaire (PHQ) is a diagnostic tool for mental health disorders used by health care professionals that is quick and easy for patients to complete. In the mid-1990s, Robert L. Spitzer, MD, Janet B.W. Williams, DSW, and Kurt Kroenke, MD, and colleagues at Columbia University developed the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool containing modules on 12 different mental health disorders. They worked in collaboration with researchers at the Regenstrief Institute at Indiana University and with the support of an educational grant from Pfizer Inc. During the development of PRIME-MD, Drs. Spitzer, Williams and Kroenke, created the PHQ and GAD-7 screeners. The PHQ, a self-administered version of the PRIME-MD, contains the mood (PHQ-9), anxiety, alcohol, eating, and somatoform modules as covered in the original PRIME-MD. The PHQ-9, a tool specific to depression, simply scores each of the 9 DSM-IV criteria based on the mood module from the original PRIME-MD.

PHQ-9 Printable PDF

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PHQ-9 Scoring and Interpretation

PHQ-9 Depression Severity is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of ―not at all, ―several days, ―more than half the days, and ―nearly every day, respectively. PHQ-9 total score for the nine items ranges from 0 to 27. Scores of 5, 10, 15, and 20 represent cutpoints for mild, moderate, moderately severe and severe depression, respectively. Sensitivity to change has also been confirmed.

Major Depressive Syndrome if item 1 or item 2 and five or more of items 1-9 are at least ―More than half the days (count item 9 if present at all).

Other Depressive Syndrome if item 1 or item 2 and two, three, or four of items 1-9 are at least ―More than half the days (count item 9 if present at all).

PHQ-9 Scores and Depression Severity

Table 4
PHQ-9 Score	Depression Severity
0 – 4	None-Minimal
5 – 9	Mild
10 – 14	Moderate
15 – 19	Moderately Severe
20 – 27	Severe

Cutpoint of 10 or greater is considered a "yellow flag" (i.e., drawing attention to a possible clinically significant condition), while a cutpoint of 15 is a "red flag" (i.e., targeting individuals in whom active treatment is probably warranted).

Special attention must be paid to the responses to item 9 as indicator of possible risk of self-harm.

PsyPack can automatically score the PHQ-9 assessment and prepare corresponding tables and graphs.

Further, PsyPack automatically plots a graph to help you easily track progress over time.

Sample Report of PHQ-9

Domain

Depression

What does PHQ-9 measure

The purpose of the evaluation is to:

assess depression severity,
monitor depression severity, and
screen for Major Depressive Syndrome/Other Depressive Syndrome.

Administration

Self-administered

Type of outcome tool

Clinical

Assessment modes

Questionnaire

Age and eligibility

13 years and above

Estimated time

Less than 5 minutes

Notes

Since the questionnaire relies on client self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the client understood the questionnaire, as well as other relevant information from the client.

Diagnosis of Major Depressive Disorder or Other Depressive Disorder also require impairment of social, occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), a physical disorder and medication, or other drug as the biological cause of the depressive symptoms.

Endorsement of item 9 (Suicidal Thoughts) is an indicator of possible suicidal risk. A final decision about the actual risk of self-harm requires further assessment and clinical interview. Further assessment of suicide risk can be made by asking about the “4 P’s”: past suicide attempts, a plan, probability of completing suicide, and preventive factors.

The final question on the PHQ-9 asks the clients to report ―how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? This single client-rated difficulty item is not used in calculating the PHQ-9 score or diagnosis but rather represents the patient‘s global impression of symptom-related impairment. It may be useful in decisions regarding initiation of or adjustments to treatment since it is strongly associated with both psychiatric symptom severity as well as multiple measures of impairment and health-related quality of life.

Sensitivity to change for monitoring treatment outcomes: A particularly important use of a measure is its responsiveness to changes of condition severity over time. This is well-established for the PHQ-9 which is increasingly used as a measure to assess the level of depression severity (for initial treatment decisions) as well as an outcome tool (to determine treatment response)

After making a provisional diagnosis with the PHQ-9, there are additional clinical considerations that may affect decisions about management and treatment.

Have current symptoms been triggered by psychosocial stressor(s)?
What is the duration of the current disturbance and has the patient received any treatment for it? To what extent are the patient’s symptoms impairing his or her usual work and activities?
Is there a history of similar episodes, and were they treated?
Is there a family history of similar conditions?

Attribution and References

Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.

Official website

Archived link