PHQ-9: Depression Screening
The PHQ-9 (Patient Health Questionnaire-9) is a nine-item self-report measure used to screen for depression severity, scored 0-27, widely used in routine outcome monitoring.
What Is the PHQ-9?
The Patient Health Questionnaire-9 is the most widely used depression screening and monitoring tool in clinical practice. It consists of nine items corresponding to the nine DSM-5 criteria for major depressive disorder, each scored from 0 (not at all) to 3 (nearly every day).
Scoring and Clinical Cutoffs
| Score Range | Severity | Clinical Action |
|---|---|---|
| 0-4 | Minimal | No treatment typically needed |
| 5-9 | Mild | Watchful waiting; consider treatment if symptoms persist |
| 10-14 | Moderate | Treatment plan indicated |
| 15-19 | Moderately severe | Active treatment with therapy and/or medication |
| 20-27 | Severe | Immediate treatment; consider combined therapy and medication |
A reliable change index of 5+ points indicates clinically meaningful change beyond measurement error. For example, a drop from 18 to 12 represents real improvement, while a drop from 18 to 15 may reflect normal score variability.
Clinical Applications
Routine Outcome Monitoring
Administer the PHQ-9 at intake and every 2-4 sessions to track treatment response. Embedding scores in your progress notes creates a quantified treatment narrative that supports insurance reauthorisation and demonstrates medical necessity.
Treatment Plan Objectives
Reference PHQ-9 targets directly in your treatment plan: “Client will reduce PHQ-9 score from 19 (moderately severe) to below 10 (mild) within 12 weeks.”
Item 9: Suicidal Ideation
Track Item 9 (thoughts of self-harm or suicide) separately from the total score. A client whose total score improves but whose Item 9 rises requires immediate risk assessment regardless of overall trajectory.
Practical Tips
- Administration time: 2-3 minutes
- Cost: Free — no licensing fees
- Format: Paper, digital, or administered verbally
- Frequency: Every 2-4 sessions for routine monitoring; weekly during acute treatment
For a comprehensive guide to implementing the PHQ-9 and other measures in your practice, see our therapy outcome measures guide.
Related Resources
Risk Assessment and Safety Planning
Risk assessment is the clinical evaluation of a client's potential for self-harm, suicide, or harm to others, guiding safety planning and intervention decisions.
PCL-5: PTSD Screening
The PCL-5 (PTSD Checklist for DSM-5) is a 20-item self-report measure for assessing PTSD symptom severity across all four DSM-5 symptom clusters, scored 0-80.
GAD-7: Anxiety Screening
The GAD-7 (Generalised Anxiety Disorder-7) is a seven-item self-report measure used to screen for anxiety severity, scored 0-21, commonly paired with the PHQ-9.
Treatment Plans
A treatment plan is a structured document that outlines a client's diagnoses, therapeutic goals, interventions, and measurable objectives to guide the course of therapy.
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