PHQ-9 explained: what your depression screening score means

What the PHQ-9 actually is

The PHQ-9 is a 9-item self-report questionnaire that maps directly to the DSM-5 criteria for major depressive disorder. It asks how often, over the past two weeks, you've been bothered by each of nine symptoms — low interest, low mood, sleep changes, fatigue, appetite changes, feelings of worthlessness, concentration problems, psychomotor changes, and thoughts of self-harm.

Each item is scored 0 (not at all) to 3 (nearly every day), yielding a total of 0 to 27. It takes about two minutes to complete. It was developed by Pfizer-affiliated researchers (Spitzer, Kroenke, Williams) in the late 1990s and is in the public domain — meaning anyone can use it without licensing fees, which is part of why it's so widely adopted.

It's the most-used depression screening tool in the United States and is endorsed by the U.S. Preventive Services Task Force for routine depression screening in adults.

What each score range means

0–4: Minimal symptoms

Your responses don't reflect significant depressive symptoms over the past two weeks. This doesn't mean nothing is wrong — many people with subclinical mood difficulty, situational stress, or grief score in this range. But it's not consistent with major depressive disorder. Watchful observation, lifestyle support, or therapy alone are usually reasonable when scores are this low.

5–9: Mild depression

Suggestive of mild depressive symptoms. Many patients in this range benefit from therapy alone, or from lifestyle interventions targeting sleep, exercise, and structure. Antidepressant medication is sometimes appropriate, sometimes not — at this severity, the clinical judgment depends heavily on duration of symptoms, functional impairment, and prior history.

10–14: Moderate depression

This is the inflection point for active treatment. Most clinical guidelines recommend therapy, medication, or both at this score level. Roughly two-thirds of patients in this range have meaningful functional impairment and significant subjective distress.

15–19: Moderately severe depression

Active treatment is strongly recommended. Both psychotherapy and antidepressant medication are usually considered, often together. The functional impairment at this score range is typically significant — work, relationships, and basic self-care are affected.

20–27: Severe depression

Active treatment is strongly indicated. Combined psychotherapy and medication is typical. Same-week clinical follow-up is appropriate. At the upper end of this range, hospital-level care should be considered, particularly if item 9 (self-harm) is endorsed at higher frequencies.

Why item 9 matters separately

Item 9 asks specifically about thoughts of being better off dead or hurting yourself. It's the only item on the scale that we always follow up on individually, regardless of the total score. A patient with a total PHQ-9 of 7 — technically "mild depression" — who endorses item 9 needs the same clinical attention as a patient with a much higher total but a 0 on item 9.

Endorsing item 9 doesn't automatically mean someone needs hospitalization or aggressive intervention. It does mean the conversation about safety, plan, and supports happens in detail rather than being skipped. Most patients who endorse item 9 are experiencing passive ideation (thoughts of being better off dead, without specific plans or intent), which is treated as a clinical concern but doesn't require emergency intervention.

If you ever endorse this item on the PHQ-9 and your prescriber doesn't follow up on it, that's a quality-of-care problem worth flagging.

Tracking PHQ-9 scores over time

Any single PHQ-9 score is a snapshot of two weeks of symptoms — useful, but limited. The clinical power of the tool is in tracking. A baseline PHQ-9 of 16 followed by 12 at week 4, 9 at week 8, and 6 at week 12 tells us the treatment is working. The same baseline of 16 still sitting at 14 at week 8 tells us the treatment isn't working and a change is appropriate.

At MindHealth Psychiatry, we use brief PHQ-9 re-assessments between visits and at each follow-up to track treatment response. This is what "measurement-based care" means in practice — making medication and treatment decisions based on actual symptom data rather than impressions.

The clinical convention for treatment response is a 50% reduction in PHQ-9 from baseline; full remission is a score below 5.

What a PHQ-9 score can't tell you

• Whether it's actually major depression. The PHQ-9 maps to MDD criteria but can be elevated by adjustment disorders, grief, bipolar depression, medical illnesses (thyroid, anemia, chronic pain), substance use, sleep disorders, and chronic stress. A high score is a flag, not a diagnosis.
• Whether you need medication, therapy, or both. Score severity informs the decision but doesn't dictate it. Patient preference, prior treatment response, comorbidities, and life circumstances all matter.
• Whether you have other psychiatric conditions. The PHQ-9 doesn't screen for anxiety, ADHD, PTSD, or bipolar disorder. A full evaluation looks at the whole picture.
• How to feel about your score. A high score isn't a personal failure; a low score doesn't mean you're not allowed to feel bad. The instrument is descriptive, not normative.

What to do with your score

If your PHQ-9 is above 10, that's a reasonable threshold to talk to a clinician. Above 15, sooner rather than later. Above 20, this week. If you've endorsed item 9 at any frequency, talking to someone is appropriate regardless of total score — and if you're in any kind of immediate crisis, call or text 988 or go to your nearest emergency room.

You can take the PHQ-9 anonymously on our screeners page and print the results to bring to your first visit.

Frequently asked questions