What Is PHQ-9?
Patient Health Questionnaire-9 (PHQ-9) is one of the most widely used, evidence-based tools for screening, diagnosing, and monitoring depression severity in clinical practice.
Developed by Drs. Kurt Kroenke, Robert Spitzer, and Janet Williams, PHQ-9 is grounded in the DSM diagnostic criteria for major depressive disorder. It is brief, reliable, and easy for clients to complete — making it ideal for routine use in therapy.
For therapists, PHQ-9 provides a structured way to understand depressive symptoms, track change over time, and support clinical decision-making without adding unnecessary burden to sessions.
What PHQ-9 Measures
PHQ-9 consists of 9 questions, each reflecting a core symptom of depression experienced over the past two weeks, including:
- Low mood or hopelessness
- Loss of interest or pleasure
- Sleep disturbances
- Fatigue or low energy
- Changes in appetite
- Feelings of worthlessness or guilt
- Difficulty concentrating
- Psychomotor changes (slowing or agitation)
- Thoughts of self-harm or death
Clients rate how often they’ve experienced each symptom, allowing therapists to assess both presence and severity of depression.
Each item on the PHQ-9is scored on a 0–3 scale:
- 0 – Not at all
- 1 – Several days
- 2 – More than half the days
- 3 – Nearly every day
Total Score Range
- Minimum score: 0
- Maximum score: 27
Interpreting PHQ-9 Scores
Score Range
0–4
5–9
10–14
15–19
20–27
Depression Severity
Minimal or none
Mild
Moderate
Moderately severe
Severe
A score of 10 or above is commonly used as a clinical threshold for identifying clinically significant depression.
Important Clinical Note
Question 9 (suicidal ideation) should always be reviewed individually, regardless of the total score, and followed up with appropriate clinical assessment and safety planning when indicated.
Why PHQ-9 Matters in Therapy
Administering the PHQ-9 early in treatment helps establish an objective starting point — allowing both therapist and client to see where therapy begins.
Repeated use across sessions makes improvement (or stagnation) visible. This supports:
- Measurement-Based Care (MBC)
- Feedback-Informed Treatment (FIT)
- Early detection of non-response or deterioration
PHQ-9 results open the door to meaningful dialogue:
- “What do you make of this score?”
- “Does this reflect how you’ve been feeling?”
- “Which symptoms feel most important to work on right now?”
Changes in scores can inform:
- Treatment pacing
- Modality adjustments
- Referrals or additional support
- Risk assessment
Measurement-Based Care emphasizes routine, structured feedback to improve outcomes. PHQ-9 fits seamlessly into this model by:
- Providing consistent symptom tracking
- Offering objective data alongside clinical judgment
- Strengthening therapist–client collaboration
Research shows that when therapists regularly review outcome measures with clients, engagement improves and dropout rates decrease.
MyOutcomes® integrates PHQ-9 into a secure, HIPAA-compliant platform designed specifically for therapists.
With MyOutcomes, clinicians can:
- Assign PHQ-9 digitally before or between sessions
- Automatically score responses
- View trends and changes over time
- Generate clear, readable reports
- Use data to guide session focus and treatment planning
All without spreadsheets, manual scoring, or extra administrative work.
PHQ-9 is appropriate for use with:
- Adults and older adolescents
- Clients presenting with mood concerns
- Primary care and specialty mental health settings
- Individual, group, or integrated care models
It is suitable for both initial screening and ongoing outcome monitoring.
- Brief and easy to administer
- Strong psychometric validity
- Aligned with DSM criteria
- Widely recognized and accepted
- Ideal for routine clinical use
PHQ-9 is more than a screening tool — it’s a conversation starter, progress tracker, and clinical compass.
When used consistently and collaboratively, it helps therapists move beyond intuition alone and toward clear, measurable insight into client change.
Paired with platforms like MyOutcomes®, PHQ-9 becomes part of a larger system that supports stronger therapeutic alliances, better decision-making, and improved outcomes.
Kroenke K, Spitzer RL, Williams JB. (2001). PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.
Kroenke K, Spitzer RL, Williams JB. (2003). The Patient Health Questionnaire-2. Medical Care, 41, 1284–1292.
Kroenke K, Spitzer RL. (2002). PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32, 509–521.
