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Reference: Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613

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Note: Depression should not be diagnosed or excluded solely on the basis of a PHQ-9 score. A PHQ-9 score ≥ 10 has a sensitivity of 88% and a specificity of 88% for major depression.1 Since the questionnaire relies on patient self-report, the practitioner should verify all responses. A definitive diagnosis is made taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient.

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Functional Health Assessment The instrument also includes a functional health assessment. This asks the patient how emotional difficulties or problems impact work, life at home, or relationships with other people. Patient response of‘very difficult’or‘extremely difficult’suggest that the patient’s functionality is impaired. After treatment begins, functional status and number score can be measured to assess patient improvement.

PHQ 9

Patient Health Questionnaire (PHQ-9)

Over the last 2 weeks, how often have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way
If you checked off any problems, 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?

How to Score the PHQ-9

Major depressive disorder (MDD) is suggested if:


• Of the 9 items, 5 or more are checked as at least "more than half the days"

• Either item 1 or 2 is checked as at least "more than half the days"

Other depressive syndrome is suggested if:


• Of the 9 items, between 2 to 4 are checked as at least "more than half the days"

• Either item 1 or 2 is checked as at least "more than half the days"

PHQ-9 scores can be used to plan and monitor treatment.


To score the instrument, tally the numbers of all the checked responses under each heading (not at all=0, several days=1, more than half the days=2, and nearly every day=3).


Add the numbers together to total the score on the bottom of the questionnaire. Interpret the score by using the guide listed below.

Guide for Interpreting PHQ-9 Scores

Score 0 to 4 - Depression Severity: None-minimal

Action - Patient may not need depression treatment.

Score 5 to 9 - Depression Severity: Mild

Action - Use clinical judgment about treatment, based on patient’s duration of symptoms and functional impairment.

Score 10 to 14 - Depression Severity: Moderate

Action - Use clinical judgment about treatment, based on patient’s duration of symptoms and functional impairment.

Score 15 to 19 - Depression Severity: Moderately severe

Action - Treat using antidepressants, psychotherapy or a combination of treatment.

Score 20 to 27 - Depression Severity: Severe

Action - Treat using antidepressants with or without psychotherapy

Severity
Date
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