A guide to the PHQ-9 assessment

About the PHQ-9 Assessment

Recommended Frequency: every 2 weeks

The PHQ-9 assessment is a nine-item questionnaire that scores diagnostic criteria for major depression from “0” (not at all) to “3” (nearly every day). It was developed in 2001 by Kurt Kroenke, MD, and colleagues to offer a new, brief measure of depression severity.

As such, the PHQ-9 combines diagnostic criteria for depression from the DSM-IV with items related to other common major depressive symptoms. Some of the most significant diagnostic symptom criteria that were adapted into items on the PHQ-9 include:

• Anhedonia – the inability or reduced ability to experience pleasure
• Depressed mood
• Cognitions, such as feelings of guilt or worthlessness
• Physical symptoms, such as a change in appetite or sleep

Scores from patient responses to each item are then used to determine the severity of depression symptoms, from mild to severe.

PHQ-9 Confidence Intervals

The authors of the PHQ-9 recommend a cut-point score of 10, which has a sensitivity of 88% and a specificity of 88% for major depression. In other words, a score of 10 or above on the questionnaire can indicate that a diagnosis of depression is warranted.

Given its specificity, sensitivity, and high validity, the PHQ-9 is a popular scale for monitoring depression. It’s often preferable to other measures because of its brevity and simplicity, which makes it more likely that patients will regularly complete their assessments.

Who is the PHQ-9 for?

Given its design and intention, the PHQ-9 may be a good fit for patients or clients who are experiencing signs of depression or who are diagnosed with another mental health condition.

More specifically, if your answer to each of the following questions is “no,” the PHQ-9 might be beneficial to use with your patient:

• Is the individual under 18 years of age?
• Is the individual experiencing normal grief or bereavement? (i.e., having recently lost a family member or experienced another potentially distressing major life event)
• Does the individual have a history of manic episodes or bipolar disorder?
• Does the individual have a physical health disorder, take medications, or use other substances that may be the cause of depressive symptoms?

Understanding the PHQ-9 Scale

The scale used during the PHQ-9 is made of nine items and asks patients or clients to self-report their symptoms. The questionnaire asks patients to answer based on their experiences over the past two weeks to provide a well-rounded assessment of severity.

Below is an example of the PHQ-9 assessment scale as it is used to measure patient responses:

Over the last 2 weeks, how often have you been bothered by any of the following problems? *Note: Question 9 is meant to identify suicide risk and should be considered an individual screening question. A score of 1 or above on this item indicates that a patient needs further assessment to determine their risk level and inform the best next steps to take.

In some cases, an additional measure may be offered to patients who indicate they experience any item listed above. This is often meant to evaluate the extent to which depression symptoms have impacted a person’s quality of life.

 

Other measures may be added for specific patients to screen for related mental health conditions, such as bipolar disorder or generalized anxiety disorder.

PHQ-9 Scoring

The severity of depressive symptoms is determined by adding up the scores from each column on the scale. The total can then be compared to the scoring guidelines shown below:

Regular and repeat assessments enable providers to record changes in depression severity or symptom frequency as treatment progresses. In this way, PHQ-9 assessments help support better treatment outcomes and provide vital measurements of care quality.

A score of 10 or above indicates that a diagnosis of major depressive disorder may be considered. If a patient responds to two to four of the items in the shaded sections (one of which must be question #1 or #2), other depressive disorders may be present.

Even if a client does not meet the criteria to have “moderate” to “severe” depression, their symptoms can still be valid and impactful. A score above zero is enough to prompt a deeper dive into the symptoms patients report and their potential causes.

As such, the PHQ-9 can inform treatment approaches regardless of the severity of a patient’s experiences.

Access the PHQ-9 & More Clinical Assessments

Diagnostic instruments like the PHQ-9 offer providers a chance to monitor symptoms at individual moments in time, but they tend to be most beneficial when used as regular screening tools.

Review the questions on the PHQ-9 with your patients before they complete their initial questionnaire, then repeat the assessment as recommended to track the evolution of symptoms. In doing so, you can directly identify the efficacy of the treatment you offer, pinpoint areas of need, and deliver better-quality care.

Linear Health makes it simple to achieve each of these goals without overloading your team with administrative work. Send and receive digital PHQ-9 assessments before, during, or after appointments to check in with your patients and revisit past scores to track changes over time.

Our goal is to give behavioral healthcare providers the tools they need to offer engaging, effective, and transformative care. Clinical assessments are just one piece of the puzzle. Want to learn more? Reach out to schedule your demo today.