How troubled are you by depression symptoms? The PHQ-9 (Patient Health Questionnaire, 9 items) provides a validated answer in nine questions and is today the most widely used tool for screening depression in primary care, mental-health settings and research worldwide.
This guide explains how the PHQ-9 works, what the five severity bands mean, why the ninth question on self-harm plays a special role, and what to do after you see your result.
This is a screening tool, not a medical diagnosis. If your score is 10 or above, or you have concerns, please consult a healthcare professional. If you have thoughts of self-harm, get help now — contact your local emergency services or a crisis line immediately (US: call or text 988; UK: 116 123).
What is the PHQ-9?
The PHQ-9 was developed and validated in 2001 by Kroenke, Spitzer and Williams in the Journal of General Internal Medicine. It maps the nine core symptoms of major depression from the DSM diagnostic manual directly into questions and asks how often they have bothered you over the past 2 weeks. Each item is scored 0 (Not at all) to 3 (Nearly every day), with a total range of 0–27.
At a cutoff of 10, the PHQ-9 has a sensitivity and specificity of roughly 88 % each for major depression. It is in the public domain and free to use — one reason for its global adoption.
The nine questions
“Over the last 2 weeks, how often have you been bothered by any of the following problems?”
- 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 are a failure
- Trouble concentrating on things
- Moving or speaking slowly — or the opposite, being fidgety or restless
- Thoughts that you would be better off dead, or of hurting yourself
Response options: Not at all (0), Several days (1), More than half the days (2), Nearly every day (3).
Severity bands
| Score | Severity | Meaning |
|---|---|---|
| 0 – 4 | Minimal | Minimal symptoms — keep monitoring |
| 5 – 9 | Mild | Self-care, support, re-test in 2–4 weeks |
| 10 – 14 | Moderate | Consult a healthcare professional, further evaluation |
| 15 – 19 | Moderately severe | Seek professional help promptly — active treatment recommended |
| 20 – 27 | Severe | Seek professional help promptly — treatment strongly recommended |
A cutoff of 10 is the established threshold for further clinical evaluation. A change of ≥ 5 points on follow-up is considered clinically meaningful and useful for tracking response to treatment.
The special role of question 9
Unlike every other item, the ninth question on self-harm stands on its own. It asks about thoughts of being better off dead or of hurting yourself. Anyone who selects more than “Not at all” here should seek support immediately — regardless of the total score, even if the other eight questions are low and the total sits in the minimal range.
That is exactly why the calculator shows a separate, prominently highlighted note whenever item 9 is positive. A low total with a positive item 9 is the critical case that is easily missed. Suicidal thoughts are a medical emergency — please do not hesitate to reach out for help.
What the PHQ-9 does not replace
The PHQ-9 captures symptom frequency, not cause. Hypothyroidism, iron deficiency, chronic sleep loss, certain medications and other medical conditions can mimic a depression picture. An elevated score should therefore always be put in context by a clinician.
The PHQ-9 also does not separate depression from anxiety — the two frequently occur together. In practice, the PHQ-9 and the GAD-7 are therefore often used together.
What to do next
- Score < 5: Symptoms minimal. Keep monitoring and reduce stressors.
- Score 5–9: Self-care — sleep, exercise, social contact, daily structure. Re-test in 2–4 weeks.
- Score ≥ 10: Make an appointment with your GP or a mental-health professional. Psychotherapy is well evidenced; medication (e.g. SSRIs) is also an option.
- Thoughts of self-harm — regardless of score: contact your local emergency services or a crisis line immediately (US: call or text 988; UK: 116 123 Samaritans).
Related topics & calculators
- GAD-7 anxiety screening — depression and anxiety frequently occur together. The GAD-7 complements the PHQ-9 for a fuller picture. Read the GAD-7 guide.
- Sleep cycles — sleep problems are a core symptom of depression (question 3). Regular sleep often directly affects the PHQ-9 score. Read the sleep cycle guide.
- Biological age — persistent depression and chronic stress accelerate ageing. A look at biological age puts lifestyle factors in context. Read the biological age guide.
Take the PHQ-9 now
Nine questions, anonymous, instant. Get an immediate interpretation of your depression symptoms over the past 2 weeks.
Go to the PHQ-9 depression screening →Frequently asked questions
How often should I take the PHQ-9?
A baseline first, then every 2–4 weeks during treatment or whenever symptoms change. Trends across multiple tests are more meaningful than any single value.
I answered question 9 — what now?
Any answer other than “Not at all” on question 9 is a serious signal, regardless of your total score. Please get help immediately — in the US call or text 988 (Suicide & Crisis Lifeline); in the UK call 116 123 (Samaritans); elsewhere contact your local emergency number. You do not have to face this alone.
Is the PHQ-9 suitable for teenagers?
The PHQ-9 is validated for adults. For adolescents there is an adapted version, the PHQ-A. For younger children, age-specific instruments are preferred.
Does the PHQ-9 also detect anxiety disorders?
No, the PHQ-9 is optimized for depression. For anxiety, the GAD-7 complements it. In practice the two are often used together, as depression and anxiety frequently co-occur.
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