All About the PHQ-9: Patient Healthcare Questionnaire for Depression

The PHQ-9 is one module of the Patient Health Questionnaire and includes nine short, simple questions. These questions were designed to help healthcare professionals identify signs or symptoms of depression. Though, you can also take it on your own.

PHQ-9 Uses

The PHQ-9 is a tool often used for regular depression screenings during primary care visits or checkups. It may also be part of a more comprehensive assessment. For example, it is a required quarterly test as part of the Minimum Data Set that the Centers for Medicare and Medicaid Services require for all nursing home residents.

The PHQ-9 may be a part of a complete psychiatric screening process that evaluates all areas of mental health. Some practitioners use the full three-page PHQ assessment to assess whether certain mental health issues may be causing or increasing a patient's physical health concerns.

In addition to looking at depression, the complete PHQ asks about anxiety, alcohol use, and eating behaviors. Patients' answers can help identify potential issues in these areas.

PHQ-9 Questionnaire Components

The PHQ-9 test evaluates several factors. These factors revolve around the criteria used to professionally diagnose depression under the current "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) and include:

• Feeling depressed or irritable
• Loss of interest or loss of pleasure in doing things
• Overeating or loss of appetite
• Sleep issues (either sleeping too much or trouble falling or staying asleep)
• Moving or speaking slowly, or the opposite, speaking quickly or being fidgety
• Feeling fatigued or lacking energy
• Feeling like a failure, or that you have disappointed your family or yourself
• Difficulty concentrating, such as when watching TV or reading a news app
• Thinking you'd be better off dead or wishing you could hurt yourself somehow

For each question, which is really presented as a statement, you are asked how often you have experienced that specific feeling or situation in the past two weeks. Possible answers include: not at all, several days, more than half the days, or nearly every day.

The PHQ-9 test also includes a tenth question. It is answered if any of the previous nine questions reveal that depression may exist. This final question asks how hard is it for you to work, take care of things at home, or get along with others.

Your answer choices to this question are: not at all, somewhat difficult, very difficult, or extremely difficult. This helps identify how much depression may be impacting your life.

PHQ-9 Scoring

Scoring for each of the nine PHQ-9 questions (or statements) ranges from zero points to three points, depending on the answer. These scores are assigned as follows:

• Not at all: 0 points
• Several days: 1 point
• More than half of the days: 2 points
• Almost all of the days: 3 points

The total score is calculated and can range from zero to 27. What does your score mean?

• A score of 20 or higher indicates that severe major depression likely exists and a combination of antidepressant medication and psychotherapy (therapeutic counseling) may be the best treatment approach.
• Scoring between 15 and 19 suggests that there is possibly moderately severe major depression, and either antidepressants or psychotherapy would likely be appropriate.
• Scoring between 10 and 14 means that you may have a moderate severity depression, with numbers in this range generally leading to recommendations for medication or psychotherapy.
• A score between 5 and 9 reveals that mild symptoms of depression appear to exist, which might warrant closer observation and re-evaluation after a certain period of time.

Accuracy of the PHQ-9

Multiple research studies have evaluated the reliability and consistency, as well as the validity and accuracy, of the PHQ-9. The results have repeatedly demonstrated that the PHQ-9 is an effective way to measure depression.

One such study was published in 2019 and looked at 58 different pieces of research involving the PHQ-9 test. In total, 17,357 men and women were assessed. They were from all age groups. Some had been diagnosed with a mental health issue and others had never received a mental health diagnosis.

After looking at the data collected from each person involved, the authors concluded that the PHQ-9 was more sensitive than a diagnostic interview. Thus, it was better at picking up major depression.

Other studies have set out to determine if the PHQ-9 is still accurate if the person taking the test has other health conditions. Many have reported that it is, some of which have involved patients with epilepsy and other medical issues.

Additionally, one study found that the PHQ-9 can be administered over the phone and will provide fairly accurate results. This may be beneficial in following up with people who are unable or unwilling to come to an onsite appointment.

Why Is Evaluating Depression So Important?

Depression can manifest itself in several ways. In addition to the typical sadness and hopeless feelings it can create, depression can also contribute to many physical symptoms that drive people to seek medical care. These include pain, gastrointestinal issues, and headaches.

While there may be a medical reason for these symptoms to be present, sometimes they are more related to a mental health condition such as depression or anxiety. Correctly identifying the underlying cause leads to more effective treatment.

Depression is one of the more treatable mental health conditions, either with psychotherapy, medication, or a combination of both. Healthcare professionals are providing quality care to their patients when they adequately address the whole person, including the mental health component.

Treating underlying depression can improve quality of life, as well as potentially save financial resources that may be incorrectly directed towards treating physical issues instead of the more appropriate mental health concerns.

A Word From Verywell

The PHQ-9 is a test that can be self-administered. It does not require significant training to take or score, making it a simple and effective way to evaluate depression.

The PHQ-9 is also short and can be completed in just a couple of minutes. This free test has been shown to be effective in multiple settings and situations.

Identifying depression is an important step in effectively treating the whole person. The PHQ-9 is an accurate measure of depression, accomplishing this task both quickly and easily.