Patient Health Questionnaire(PHQ)-9

Use as a depression screening tool:
  • To assist the clinician in making the diagnosis of depression.
  • To quantify depression symptoms and monitor severity.
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?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
2. Feeling down, depressed, or hopeless?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
3. Trouble falling or staying asleep, or sleeping too much?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
4. Feeling tired or having little energy?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
5. Poor appetite or overeating?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
7. Trouble concentrating on things, such as reading the newspaper or watching television?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
8. Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
9. Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?
Not at all
0
Several days
1
More than half the days
2
Nearly every day
3
If any of the above were selected other than “Not at all”:
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?

Optional; not included in final score but may help assess global impairment
Not difficult at all
0
Somewhat difficult
0
Very difficult
0
Extremely difficult
0

0 Points

Reset
Scores ≤ 4 suggest minimal depression which may not require treatment.

Functionally, the patient does not report limitations due to their symptoms.
    Patient Name:
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    What PHQ-9 Means

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    The PHQ-9 is a 9-question instrument given to patients in a primary care setting to screen for the presence and severity of depression. It is the 9-question depression scale from the Patient Health Questionnaire (PHQ). The results of the PHQ-9 may be used to make a depression diagnosis according to DSM-IV criteria and takes less than 3 minutes to complete. The total of all 9 responses from the PHQ-9 aims to predict the presence and severity of depression. Primary care providers frequently use the PHQ-9 to screen for depression in patients.

    Interpretation of Results

    The total sum of the responses suggests varying levels of depression. Scores range from 0 to 27. In general, a total of 10 or above is suggestive of the presence of depression. Listed below are PHQ-9 totals, the levels of depression that they relate to, and suggested treatment for each level of depression:

    Score Depression severity Comments
    0-4 Minimal or None Monitor; May not require treatment
    5-9 Mild Repeat PHQ-9 at follow-up.
    10-14 Moderate Use clinical judgment (symptom duration, functional impairment) to determine necessity of treatment. Consider counseling, follow-up, and/or prescription drugs.
    15-19 Moderately Severe Warrants active treatment with psychotherapy, medications, or combination. Prescribe prescription drugs. If there are poor responses to treatment, immediately refer the patient to a mental health specialist for counseling.
    20-27 Severe

    A provisional diagnosis of Major Depressive Disorder can be made by using responses to PHQ-9 questions to fulfill the diagnostic criteria of DSM-5. According to DSM-5, Major Depressive Disorder is likely if 5 or more of the 9 symptoms are present for “most of the day, nearly every day" in the past 2 weeks and one of the symptoms is depressed mood or little interest or pleasure in doing things (questions 1 and 2 on the PHQ-9). Any degree of suicidal thoughts counts toward this criteria. The symptoms must also cause significant distress and loss of function, and the symptoms must not be better explained by substance use or another medical or psychiatric condition. “Other” depression is diagnosed if there is significant impairment and/or distress in major areas of functioning, but the full criteria for any specific depressive disorder are not met.[5] The PHQ-9 can be used to diagnose Major Depressive Syndrome, but Major Depressive Disorder must be diagnosed using additional clinical information (e.g. existence of past manic/hypomanic episode, bereavement, other mental disorder, effects of a medication or illness)

    Clinicians may also use the PHQ-9 to evaluate treatments given for depression. A change of PHQ-9 score to less than 10 is considered a “partial response” to treatment and a change of PHQ-9 score to less than 5 is considered to be “remission.”

    Evidence Appraisal

    • PHQ-9 score of ≥ 10 has a sensitivity of 88% and a specificity of 88% in detecting MDD.
    • Criterion and construct validity of the scale was assessed in 3,000 primary care patients and replicated in 3,000 obstetrics-gynecology patients.

    Pearls/Pitfalls

    • The Patient Health Questionnaire (PHQ)-9 is the Major Depressive Disorder (MDD) module of the full PHQ.
    • Used to provisionally diagnose depression and grade severity of symptoms in general medical and mental health settings.
    • Scores each of the 9 DSM criteria of MDD as “0” (not at all) to “3” (nearly every day), providing a 0-27 severity score.
    • The last item (“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?”) is not included in score, but is a good indicator of the patient’s global impairment and can be used to track treatment response.
    • Higher PHQ-9 scores are associated with decreased functional status and increased symptom-related difficulties, sick days and healthcare utilization.