PHQ-9: Scoring, Cutoffs & Depression

PHQ-9: Scoring, Cutoffs, and Depression Screening Workflow

PHQ-9 guide — item structure, scoring table with cutoffs (5/10/15/20), validation psychometrics, public-domain licensing, and facility workflow.

How to use this page

Use this page to understand PHQ-9 scoring and to plan depression-screening documentation workflows. A PHQ-9 score supports — but never replaces — clinician judgment; keep patient-specific decisions in your clinical and payer workflows.

Last source check: June 12, 2026

Plan the measurement workflow

Use these sections to plan ownership, documentation, and follow-up around validated measure materials and your program's care workflows.

Capture The Review Context

• Record why PHQ-9 is being used in the program workflow and who is responsible for reviewing results.
• Keep source access, attribution, and version details connected to any local form workflow.

Route Follow-Up Work

• Connect repeated review to progress-note and treatment-plan workflows rather than treating a score as a standalone decision.
• Set timing through program policy and clinical review instead of using a universal cadence.
• Define the same-visit follow-up path for a positive item-9 response before screening begins.

Route Decisions Through Clinical Review

• Configure measure wording, score context, documentation handoffs, and follow-up steps around validated source materials.
• Keep diagnosis, placement, medical-necessity, and coverage decisions in the team's clinical and payer workflows.

What the PHQ-9 Is

The Patient Health Questionnaire-9 (PHQ-9) is a nine-item, self-report depression measure. The patient rates how often each symptom has bothered them over the past two weeks on a 0–3 frequency scale (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day), for a total score of 0–27. The nine items track the nine DSM criteria for a major depressive episode, which is what makes the instrument useful both as a screen and as a repeated severity measure.

The PHQ-9 was developed by Kurt Kroenke, Robert Spitzer, and Janet Williams as part of the Patient Health Questionnaire family, with development funded by an educational grant from Pfizer, and validated in a 2001 study in the Journal of General Internal Medicine ↗. The instrument is in the public domain — PHQ Screeners ↗, the official source site, states the PHQ family may be reproduced, translated, displayed, or distributed without permission.

What the Nine Items Cover

Rather than reproducing the questionnaire here, the table below describes the symptom domain each item addresses. For the exact item wording and current translations, use the source forms at phqscreeners.com ↗ and keep the attribution that appears on them.

A tenth, unscored question asks how difficult the endorsed problems have made it to work, manage home responsibilities, or get along with others — useful functional-impact context for treatment planning and payer documentation.

If you teach or supervise interview-based screening, the SIGECAPS mnemonic covers the same nine symptom domains in interview form — see our SIGECAPS depression mnemonic guide.

PHQ-9 Scoring Table and Cutoffs

Add the nine item scores for a total of 0–27, then interpret against the published severity bands:

* Response pathways are program- and clinician-determined; the bands orient severity, they do not prescribe treatment.

A total score of 10 or higher is the threshold most commonly used to flag a patient for further diagnostic evaluation ( Kroenke, Spitzer & Williams, 2001 ↗ ).

Item 9 is a workflow trigger, not just a data point. Any positive response to item 9 (thoughts of death or self-harm) warrants same-visit risk follow-up under your program’s suicide-risk protocol — structured risk assessment, safety planning as clinically indicated, and documentation of the response taken. Define that pathway before you start screening. Crisis resource for patients and families: call or text 988 (Suicide & Crisis Lifeline).

Psychometrics: Why the ≥10 Cutoff

In the 2001 validation study across 3,000 primary-care and 3,000 obstetrics-gynecology patients, a PHQ-9 score of ≥10 had 88% sensitivity and 88% specificity for major depression ( J Gen Intern Med 2001;16:606–613 ↗ ). The study also reported strong internal consistency across both samples, and good test-retest reliability when the questionnaire was repeated within 48 hours.

Two properties matter beyond the headline cutoff. First, the PHQ-9 functions as a continuous severity measure, not just a screen — scores track symptom burden closely enough that the validation work treats increasing scores as increasing probability and severity of depression, which is what makes repeated administration meaningful for outcome monitoring. Second, the instrument is sensitive to change: a falling score across administrations is interpretable as symptom improvement, which is why measurement-based-care programs chart PHQ-9 trends rather than single results. A drop of five points or more between administrations is often treated as a clinically meaningful response in measurement-based-care protocols.

The U.S. Preventive Services Task Force recommends screening adults for depression ↗, and the PHQ-9 is among the most widely used instruments for meeting that recommendation.

PHQ-2 First, PHQ-9 to Confirm

The PHQ-2 consists of the first two PHQ-9 items (anhedonia and depressed mood), scored the same way for a total of 0–6. Many programs use it as an ultra-brief first-stage screen: a positive PHQ-2 steps up to the full PHQ-9 the same visit.

The two-stage design solves a real workflow problem. Front-desk or nursing staff can administer two questions to every patient at every visit without meaningful time cost; only positives generate the nine-item follow-up and the clinical review it requires. That keeps universal screening sustainable in high-volume settings — and it means a negative PHQ-2 still gets documented, which matters when a payer or surveyor asks whether the program actually screens everyone it says it screens. This two-stage pathway is the model reflected in NYSDOH’s integrated-care guidance ↗ and underlies Medicare’s annual depression screening benefit — see our G0444 billing guide.

Special Populations and Settings

The PHQ-9 was validated in adult primary-care and obstetrics-gynecology samples, so settings outside that frame need a few adjustments:

Across all of these, the boundary from this page’s workflow framing holds: the score prompts evaluation and supports monitoring — diagnosis routes through the clinician.

• Addiction treatment. Depressive symptoms during early abstinence overlap heavily with withdrawal and post-acute withdrawal: sleep disruption, appetite change, fatigue, concentration problems, and low mood can all be substance-related. A high PHQ-9 at detox admission is a signal to monitor and re-administer as stabilization proceeds — not, by itself, evidence of an independent depressive disorder. Documenting score trajectory across the episode is more informative than any single early score, and it protects the record when diagnosis timing is questioned in review.
• Adolescents. A modified version for ages 11–17 (commonly called the PHQ-A) exists within the same public-domain family, with wording adapted for adolescents; programs serving minors should use the adolescent form from phqscreeners.com ↗ rather than the adult version.
• Older adults. Somatic items (sleep, energy, appetite) can elevate scores in patients with medical illness independent of mood. The score still orients severity, but clinical evaluation should weigh medical contributors before treatment-plan conclusions.
• Perinatal settings. The PHQ-9 was co-validated in an obstetrics-gynecology sample, and perinatal depression screening is a common use case; programs in this space often pair it with perinatal-specific protocols for follow-up.

Licensing: Public Domain, Attribution Kept

The PHQ-9 requires no license and no permission fee. PHQ Screeners ↗ states the screeners may be reproduced, translated, displayed, or distributed without permission. Keep the attribution and version details connected when you configure the instrument into local forms — that is good measurement hygiene, not a legal requirement.

This makes the PHQ-9 different from licensed depression instruments such as the Beck Depression Inventory (BDI-II), which must be purchased from its rights holder and whose items may never be reproduced.

From Score to Treatment Plan and Medical Necessity

A PHQ-9 score is most valuable when it lands somewhere: as the measurable baseline in a treatment-plan objective (for example, “reduce PHQ-9 from 18 to below 10 within 90 days, measured monthly”), and as repeated outcome evidence when a payer reviews medical necessity for continued care. Trend lines of repeated administrations show whether treatment is working in a form utilization reviewers recognize.

Connect each administration to the progress note documenting the encounter and to any treatment plan update that follows. For depression-specific planning, see our depression treatment plan guide. The boundary stays the same throughout: a score is evidence for clinical judgment, never a substitute for it, and cadence is set by program policy — not by a universal schedule.

Billing the Screening

When the PHQ-9 is administered and scored with a documented result, two codes commonly apply: CPT 96127, used for brief emotional/behavioral assessments with standardized instruments — see our 96127 billing guide — and HCPCS G0444 for Medicare annual depression screening — see our G0444 billing guide. Payer rules on frequency and same-day pairing vary; both guides cover the details in original wording.

For anxiety screening alongside depression, the companion instrument is the GAD-7, which follows the same public-domain licensing and a parallel scoring structure.

EHR supports PHQ-9 administration in-app with auto-scoring on submission. Score trending is currently available via reports; visual trend graphs are on our roadmap.

Source guidance

What the public references support

These notes summarize public reference material so behavioral-health teams can verify how an assessment fits their documentation process.

PHQ Screeners states that PHQ and GAD-7 screeners can be reproduced, translated, displayed, or distributed without permission.

Keep attribution, version, and source context connected when configuring local forms or workflows.

NIH describes PHQ-9 at a high level as measuring frequency of depressed mood and anhedonia over the past two weeks.

Use only as high-level orientation; avoid diagnosis or treatment guidance without clinical review.

PHQ-9 can be discussed as supporting repeated treatment monitoring, but exact timing should follow workflow and clinical judgment rather than a universal schedule.

Tie timing to source context, program policy, and clinical review.

Published PHQ-9 severity bands are 0–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, and 20–27 severe, with a score of 10 or higher commonly used as the threshold for further evaluation.

Severity bands orient interpretation; diagnosis and treatment decisions remain with the clinician. New claim — pending legal/clinical review.

The 2001 validation study (Kroenke, Spitzer & Williams, J Gen Intern Med) reported 88% sensitivity and 88% specificity for major depression at the cutoff of 10 or higher.

Cite the primary study; psychometrics describe study samples, not any individual patient. New claim — pending legal/clinical review.

A positive response on item 9 (thoughts of death or self-harm) warrants same-visit risk follow-up under the program's risk-assessment protocol.

Workflow framing only; route risk assessment through clinical judgment and program policy. New claim — pending legal/clinical review.

Measurement-based-care context supports standardized instruments over the course of service.

Use as accreditation and documentation context, not clinical advice.

Outcome-measure programs should document why repeated measurement is used and avoid treating a single instrument schedule as universal.

Use this to keep measurement timing tied to program policy and clinical review.

Frequently Asked Questions

Related workflow

• How is the PHQ-9 scored?
• What does a PHQ-9 score of 10 or higher mean?
• Is the PHQ-9 free to use?
• What happens if item 9 is positive?
• How can a behavioral health team operationalize PHQ-9 for measurement-based care?
• How should PHQ-9 results be used in clinical documentation and decision-making?

Continue the measurement path

References

Source material

Use these links to confirm source details and align your local assessment workflow.

Coordinate measurement review

Connect measures to next steps

Review how connects measurement review, progress notes, treatment-plan updates, reminders, and reporting tasks.

For informational purposes only: This page provides general information for behavioral-health teams evaluating assessment workflows. It is not medical, clinical, diagnostic, legal, billing, accreditation, or compliance advice, and it is not a recommendation to select, administer, score, interpret, or bill any instrument for any specific patient, program, payer, or jurisdiction. Use official measure materials, publisher and license terms, instrument instructions, validated scoring guidance, payer and accreditation requirements, program policies, and qualified clinical, compliance, and legal review. Measure names and trademarks belong to their respective owners; does not supply, reproduce, license, endorse, or replace restricted instruments, item text, scoring keys, official forms, or clinical interpretation unless expressly stated in writing.

Reference tables

Common questions

Official sources

• a 2001 study in the Journal of General Internal Medicinepubmed.ncbi.nlm.nih.gov
• NYSDOH’s integrated-care guidancehealth.ny.gov
• NIH CDE PHQ-9nih.gov
• Joint Commission measurement-based care FAQjointcommission.org