PHQ-9 Scoring, Interpretation and How to Document It

Every total from 0 to 27 falls in exactly one band. The table maps each total to its band and says where it sits, which answers questions like "what does a PHQ-9 of 9 mean" (the top of mild, one point below the moderate cut point) or "what does 21 mean" (severe).

The validation paper states that "PHQ-9 scores of 5, 10, 15, and 20 represent valid and easy-to-remember thresholds demarcating the lower limits of mild, moderate, moderately severe, and severe depression." The bands in the table above follow from those four cut points and the 0 to 27 range.

The same paper reports that, against a mental health professional interview, a PHQ-9 score of 10 or higher had a sensitivity of 88% and a specificity of 88% for major depression. That is a statement about a screening threshold in a primary care study. It is not a diagnosis, and a score alone never replaces a clinical interview.

Item 9 is the item on thoughts of death or self-harm. Its score is added into the total like every other item, so a client can land in a low severity band and still have answered item 9 above zero. Because the band does not tell you that, document the item 9 response on its own line every time. The scorer above flags any item 9 answer above zero for the same reason.

What you do next is a clinical decision under your setting's protocol. The PHQ instructions note that a four-item screener has been developed to help with positive responses to item 9, and that a final decision about the actual risk of self-harm requires a clinical interview. For related references, see the C-SSRS documentation guide, the risk assessment template and the safety plan template. This page does not set out a triage procedure.

Record the total and the band each time the PHQ-9 is given, with the date, and state the prior score next to it. A line such as "14, down from 18 at intake" lets a reviewer see direction without opening earlier notes. Keep the interpretation in your own words in the Assessment section: the form gives you a score and a band, but connecting it to the client's presentation and the treatment plan goals is your clinical judgment.

How big a change matters? In a study drawn from 434 older adults (mean age 71) in a late-life depression treatment trial, Lowe and colleagues estimated the minimal clinically important difference for individual change at 5 points on the 0 to 27 scale, using subgroups who completed the PHQ-9 twice, 7 days apart. That is one study population, so if your agency, payer or supervisor sets a different threshold, use theirs, and write any target into the depression treatment plan. The helper below shows the point change, the band change, and whether the change reaches 5 points.

They belong to the same PHQ family, and the PHQ instructions describe each one. The PHQ-2 is the first two items of the PHQ-9 and is used as an ultra-brief screener; a score of 3 or more should lead to the full PHQ-9 and a clinical interview. In its validation study, a PHQ-2 score of 3 or more had a sensitivity of 83% and a specificity of 92% for major depression. The PHQ-8 drops item 9, so it does not ask about thoughts of death or self-harm.

The PHQ-A is a substantially modified version of the PHQ developed for adolescents, and the instructions say its validity data are moderate but much less than for the original PHQ. Separately, a study of the PHQ-9 itself in 442 youth aged 13 to 17 found a cut point of 11 or more worked best for detecting major depression (sensitivity 89.5%, specificity 77.5%). Use the version and cut point your setting has adopted, and name the version in the note.

The PHQ-9 form on phqscreeners.com carries the notice "Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute." The site also states that all PHQ and GAD-7 screeners and translations are downloadable there and that no permission is required to reproduce, translate, display or distribute them, and the PHQ instructions say all the measures in the PHQ family, including the PHQ-2, PHQ-8 and PHQ-A, are in the public domain.

The site's terms of use add that Pfizer makes no warranties about the content and that use is at your own risk. WellNotes links to the official form instead of reproducing the questions, and the scorer on this page uses short topic labels, not the item wording. Nothing on this page is a substitute for the form or its terms.