Patient Health Questionnaire -9 (PHQ-9)

Advantages of the PHQ-9

This tool:

    • Is shorter than other depression rating scales
    • Can be administered in person, by telephone, or self-administered
    • Facilitates diagnosis of major depression
    • Provides assessment of symptom severity
    • Has proven effective in a geriatric population, (Löewe B, et al., 2004 Medical Care)
    • Is well validated and documented in a variety of populations

Administering and Scoring the PHQ-9

Research has shown that certain scores on the PHQ-9 are strongly correlated with a subsequent major depression diagnosis. However, not everyone with an elevated PHQ-9 is certain to have major depression. The PHQ-9 is intended as a tool to assist clinicians with identifying and diagnosing depression but is not a substitute for diagnosis by a trained clinician.

 Score  Severity
0-4 No depression
5-9 Mild depression
10-14 Moderate depression
>15 Severe depression

Clinical workflows may call for staff members who don’t have behavioral health training to distribute or administer the PHQ-9. Some clinics have the receptionist distribute the PHQ-2 or PHQ-9 for patients to complete in the waiting room. Some practices have the medical assistant give the PHQ-2 or PHQ-9 when they room the patient. When clinic staff without behavioral health training participate in screening or treatment monitoring activities it’s important to provide them with the training and support they need to feel comfortable in this role and to feel prepared to interact with patients and answer questions about the purpose of screening and treatment monitoring activities. The tool below is designed as a resource to assist these support staff in this role.

Clinics need to be prepared to handle patients who give an affirmative response to the 9th item on the PHQ-9. One of the challenges of this item is that it combines passive ideation “thoughts that you would be better off dead” with active thoughts of self-harm “thoughts of hurting yourself in some way.” The tool below is designed to help clinicians follow-up on an affirmative response to question 9.

Video Demonstration – PHQ-9

The PHQ-9 can be self-administered or clinician- administered. The video demonstrations show a care manager administering the PHQ-9 to a primary care patient in the initial visit and in the follow-up visit.

PHQ-9 Downloads

The PHQ-9 Depression Screener is available here (in English), and a version with instructions for healthcare professionals can be downloaded here.

Available Languages

The PHQ-9 Depression Screener is provided at http://www.phqscreeners.com/ in a variety of languages, including Arabic, Assamese, Chinese (Cantonese, Mandarin), Czech, Dutch, Danish, English, Finnish, French, French Canadian, German, Greek, Gujarati, Hindi, Hebrew, Hungarian, Italian, Malay, Malayalam, Norwegian, Oriya, Polish, Portuguese, Russian, Spanish, Swedish and Telugu.

Low-Literacy Visual Aids

The answer choices for the PHQ-9 can be confusing, especially for questions worded with a double negative. Some patients appreciate a visual aid that makes it easier to understand how to quantify their responses.
PHQ-9 Low-Literacy Visual Aid (English)
PHQ-9 Low Literacy Visual Aid (Spanish)