PHQ-9 Depression Scale

The PHQ-9 is the nine item depression scale of the patient health questionnaire. The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV. The PHQ-9 can function as a screening tool, an aid in diagnosis, and as a symptom tracking tool that can help track a patient’s overall depression severity as well as track the improvement of specific symptoms with treatment.

Advantages of the PHQ-9

  • Shorter than other depression rating scales
  • Can be administered in person by a clinician, by telephone, or self-administered by the patient
  • Facilitates diagnosis of major depression
  • Provides assessment of symptom severity
  • Is well validated and documented in a variety of populations
  • Can be used in adolescents as young as 12 years of age

Using in Primary Care

The PHQ-9 has been mostly validated in primary care environments but has also been used successfully in Behavioral Health Centers. It can be self-administered or clinician-administered. At the initial visit for depression care the PHQ-9 is used to assist with diagnosis and identification of problem symptoms. At the follow-up visit, the PHQ-9 is used to measure treatment response and identify specific symptoms that are not responding.

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.

Patient Health Questionnaire 2 (PHQ-2)
This is used by some clinicians and organizations to screen patients for undiagnosed depression. The PHQ-2 consists of the first two questions asked on the PHQ-9. If the patient responds affirmatively to either of the two items on the PHQ-2, the following seven questions on the PHQ-9 are asked. This can be a particularly effective way to screen large groups of people for depression. No permission is required to reproduce, translate, display or distribute the Patient Health Questionnaire (PHQ-2).

Patient Health Questionnaire 9 (PHQ-9) 
The PHQ-9 and related resources are available at www.phqscreeners.com. This includes translations of the measure as well as an instruction manual. No permission is required to reproduce, translate, display or distribute the Patient Health Questionnaire (PHQ-9).

Helping Clinic Staff Talk about the PHQ-9
This tool is designed to help clinic support staff with answers to common questions they may hear from patients to help increase their comfort talking with patients about the PHQ-9.

PHQ-9 Visual Answer Aid   English | Spanish 
This answer aid is a visual representation of the PHQ-9 answer scale.

Protocols for Suicide Prevention In Primary Care 
When a patient scores positive on question 9 of the PHQ-9, it is important to have plan for how to respond. This guide helps primary care clinics to refine existing protocol(s) for responding to patients presenting with suicidality or violent behavior in a primary care clinic.

Alternatives to the PHQ-9

The AIMS Center is of the opinion that what screening and tracking tool you choose in your setting is less important than that there is one; the important piece is that you have something in place that promotes “measurement-based treat to target” care – that is, keeping track of patient symptoms and problems and systematically tracking whether or not the treatments are helping. Several depression screening instruments have been developed and validated for use in primary care and other settings. Instruments vary by whether they are self- or interviewer-reported and applicable to patients with cognitive or language barriers.

The Geriatric Depression Scale (GDS)
This self-report instrument has been studied in multiple settings. There is a five-item version and a 15-item version of this measure. (The 15-item measure has excellent psychometric properties when compared to a structured diagnostic instrument in a sample of functionally impaired, cognitively intact, community-dwelling primary care patients.)

The Center for Epidemiologic Studies Depression Scale
This is one of the most common instruments applied in community studies and also used in primary care settings.

Cornell Scale for Depression in Dementia
This incorporates both observer and informant based information and is helpful in evaluating cognitively impaired patients for depression.

Children’s Depression Inventory
The Children’s Depression inventory (CDI) is a validated depression screener for kids ages 7 -17. It can be used in both clinical and educational settings.

AUDIT-C

The AUDIT-C is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders (including alcohol dependence). The AUDIT-C is a modified version of the 10-question AUDIT instrument.

Generalized Anxiety Disorder subscale (GAD-7)

The Generalized Anxiety Disorder (GAD) subscale of the Patient Health Questionnaire (GAD-7) is a quick and easy tool to help identify patients with anxiety and monitor treatment response. The GAD-7 is available free for clinical use in a variety of languages at the link below.

Patient Health Questionnaire 2 (PHQ-2)

The Patient Health Questionnaire 2 (PHQ-2) is used by some clinicians and organizations to screen patients for undiagnosed depression. The PHQ-2 consists of the first two questions asked on the PHQ-9. If the patient responds affirmatively to either of the two items on the PHQ-2, the following seven questions on the PHQ-9 are asked. This can be a particularly effective way to screen large groups of people for depression. *
* Li, MM, Friedman, B, Conwell, Y, Fiscella, K. Validity of the Patient Health Questionnaire 2 (PHQ-2) in Identifying Major Depression in Older People. Journal of the American Geriatric Society. 2007; 55:596-602

PHQ-9 Visual Answer Aid (Spanish)

This answer aid is a visual representation of the PHQ-9 answer scale in Spanish. Behavioral Health Care Managers can use this resource alongside the PHQ-9 during screening to get a fuller understanding of how their patient is feeling.

PHQ-9 Visual Answer Aid

This answer aid is a visual representation of the PHQ-9 answer scale.  Behavioral Health Care Managers can use this resource alongside the PHQ-9 during screening to get a fuller understanding of how their patient is feeling.