PHQ-9

Screens for and monitors severity of depression

Indication

Screens for and monitors severity of depression

Criteria

id: interest; label: Little interest or pleasure in doing things; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: depressed; label: Feeling down, depressed, or hopeless; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: sleep; label: Trouble falling/staying asleep, or sleeping too much; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: tired; label: Feeling tired or having little energy; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: appetite; label: Poor appetite or overeating; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: failure; label: Feeling bad about yourself — or that you are a failure; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: concentration; label: Trouble concentrating on things; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: psychomotor; label: Moving/speaking slowly or being fidgety/restless; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3
id: suicidal; label: Thoughts of self-harm or being better off dead; type: options; options: label: Not at all; value: 0; label: Several days; value: 1; label: More than half the days; value: 2; label: Nearly every day; value: 3

Interpretation

function(score) { if (score <= 4) return { risk: score + '/27', tier: 'Minimal Depression', action: 'Monitor. May not require treatment.', color: 'green' }; if (score <= 9) return { risk: score + '/27', tier: 'Mild Depression', action: 'Watchful waiting; repeat PHQ-9 at follow-up. Consider counseling.', color: 'green' }; if (score <= 14) return { risk: score + '/27', tier: 'Moderate Depression', action: 'Consider counseling, pharmacotherapy, or both. Treatment plan warranted.', color: 'yellow' }; if (score <= 19) return { risk: score + '/27', tier: 'Moderately Severe', action: 'Active treatment with pharmacotherapy and/or psychotherapy.', color: 'red' }; return { risk: score + '/27', tier: 'Severe Depression', action: 'Immediate initiation of pharmacotherapy. Consider psychiatry referral. Assess suicidality.', color: 'red' }; }

Clinical pearls

Item 9 (suicidality) — ANY positive response requires immediate safety assessment
PHQ-9 ≥10 has 88% sensitivity and 88% specificity for major depression
Use PHQ-2 (first 2 items) as initial screen; if ≥3, administer full PHQ-9
Useful for monitoring treatment response — ≥5-point decrease = clinically significant improvement

Source and review

Kroenke et al., J Gen Intern Med 2001. Last reviewed: 2024-11-01