PHQ-9 questions, scoring and cut points
The PHQ-9 is a nine-item depression questionnaire developed by Drs. Robert L. Spitzer, Janet B.W. Williams and Kurt Kroenke and colleagues. Items cover the last two weeks, use answers weighted 0 to 3 and produce a total from 0 to 27.
A practice builds the PHQ-9 from the owner's current wording. Intake Pro can calculate its labelled bands, while the clinical lead decides result review and the written procedure for item 9.
Last updated
- Items 9
- Score range 0 to 27
- Time frame Last 2 weeks
- Cut points 5, 10, 15 and 20
- Licence No permission required
What is the PHQ-9 and who developed it?
The Patient Health Questionnaire-9 is a depression questionnaire developed by Drs. Robert L. Spitzer, Janet B.W. Williams and Kurt Kroenke and colleagues. Its nine items ask how often problems bothered the patient during the last two weeks.
The PHQ-9 has four response choices per item, with points from 0 through 3. The item scores add to one total from 0 through 27. A later difficulty question concerns work, home life and relationships, but the instruction manual excludes that question from every score.
A practice can place the questionnaire within its broader therapy and counseling intake forms. The owner supplies the item wording, and the practice's clinical lead supplies the review procedure.
What do the nine PHQ-9 items cover?
The nine PHQ-9 items cover mood, physical state, self-perception, function and safety. A separate final item addresses daily functioning and remains unscored.
- Interest or pleasure in activities.
- Low mood.
- Sleep.
- Energy.
- Appetite.
- Feelings about oneself.
- Concentration.
- Noticeably slow movement or speech, or restlessness.
- Thoughts of self-harm.
- The separate final item covers difficulty with work, home life and getting along with other people; it is not scored.
How is the PHQ-9 scored?
PHQ-9 scoring adds nine answers weighted 0 to 3 for a total of 0 to 27. Cut points at 5, 10, 15 and 20 mark the manual's bands. A score of 10 or more is a yellow flag for a possible clinically significant condition, and 15 or more is a red flag.
| Score band | Manual label |
|---|---|
| 0 to 4 | None to minimal depression |
| 5 to 9 | Mild depression |
| 10 to 14 | Moderate depression |
| 15 to 19 | Moderately severe depression |
| 20 to 27 | Severe depression |
A score is a screening result and not a diagnosis. The practice's clinical lead decides which cut point the practice uses and what staff do with a result.
Who owns the PHQ-9 and what does its licence say?
The PHQ screeners site provides the PHQ-9 and states its reproduction terms. The practice should obtain current wording there and confirm the licence for its own planned use before building an online form.
The screeners site says the PHQ and GAD-7 screeners and their translations are downloadable from the site. It states that "no permission is required to reproduce, translate, display or distribute them".
That permission statement does not choose the practice's clinical workflow. The practice manager should preserve the owner's wording, and the clinical lead should approve scoring and staff responsibilities before publication.
How do you build the PHQ-9 in Intake Pro?
Build the PHQ-9 in Intake Pro's form builder from the owner's current wording after confirming permission. Configure one total and its bands, then test the arithmetic and review procedure before patient use.
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Obtain wording and confirm permission
Download the current PHQ-9 and manual from the owner. The practice manager confirms the reproduction terms for the planned online use.
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Add the item matrix
In the form builder, place a matrix for the nine items sharing response choices. Add the final difficulty item outside the scored matrix.
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Configure weights and bands
Use scored assessments to assign 0, 1, 2 and 3 points, total 0 to 27 and label the five bands. Keep the difficulty item unscored.
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Complete clinical review
Have the clinical lead approve the cut point, review assignments and written item 9 procedure before any links are sent ahead of visits.
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Test known responses
Enter answers with hand-calculated totals at band boundaries. Confirm the final difficulty answer never changes the total.
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Publish the reviewed form
Publish after wording, scoring and staff review checks pass. Later edits create a new version while earlier signed versions stay unchanged.
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Send within an intake packet
Place the form with other approved documents in an intake packet, then send a private link or offer it on the front-desk kiosk.
When does a practice send the PHQ-9 and who reviews it?
The practice manager follows the clinical lead's schedule for sending the PHQ-9 before visits or offering it at check-in. A clinician assigned by the practice reviews the total and answers under its written procedure.
Item 9 covers thoughts of self-harm, and the manual says a positive answer needs a clinical interview. Before sending the PHQ-9 ahead of visits, the practice needs its own written procedure, set by its clinical lead, for who reviews item 9 and how soon. A form filled in at home is not read the moment it is submitted, and Intake Pro does not alert staff.
Intake Pro keeps the total with the signed response but does not interpret the score or provide clinical decision support. Authorized staff retrieve the signed record for the practice's chart process. See the GAD-7 guide when the clinical lead also selects anxiety screening.
The patient form templates hub covers the surrounding documents, while the intake forms guide explains their place in a complete packet.
Questions
Does the PHQ-9 difficulty question change its total?
No. The final difficulty question covers work, home life and relationships, but the instruction manual excludes it from every PHQ-9 score. The nine scored items produce the total from 0 to 27.
What does a PHQ-9 score of 10 or more mean?
The manual calls 10 or more a yellow flag that draws attention to a possible clinically significant condition. It calls 15 or more a red flag. A score remains a screening result rather than a diagnosis.
Does Intake Pro alert staff to a PHQ-9 item 9 response?
No. Intake Pro does not alert staff. Before home delivery, the clinical lead must set a written procedure naming who reviews item 9 and how soon, because submission does not mean someone immediately reads the form.
Can the PHQ-9 be sent in a patient intake packet?
Yes. Staff can place the practice-built form in a packet behind one private link or offer it at a kiosk. Intake Pro keeps the calculated total with the signed response for authorized review.