What counts as a high PHQ-9 score?

The scoring guidance bands are: 0 to 4 minimal, 5 to 9 mild, 10 to 14 moderate, 15 to 19 moderately severe, and 20 to 27 severe. NHS Talking Therapies treats 10 or more as above caseness. High is context-dependent: a 12 in someone who was a 24 is a different fact from a 12 in someone who was a 4.

How often should I administer it?

Session by session is the NHS Talking Therapies pattern and works well in private practice too: it takes a minute, and frequent measurement is what makes the trend line meaningful. Fortnightly or monthly is a reasonable lighter rhythm for longer-term work. Whatever the interval, keep it consistent.

Can clients complete it at home?

Yes; it is a self-report measure and completing it before the session saves room time. Agree the routine in advance and review item 9 promptly, including when clients complete it before the session.

What does reliable change mean?

A change of 6 points or more on the PHQ-9 is unlikely to be measurement noise, which is the reliable change convention used in NHS Talking Therapies. Smaller movements are within the wobble the measure itself produces, so treat a 3-point shift as steady, not as evidence in either direction.

Does the PHQ-9 diagnose depression?

No. It measures the frequency of nine symptoms over two weeks, which is a snapshot of severity, not a diagnosis. A bereaved client, a night-shift worker and a depressed client can produce similar scores for different reasons. Diagnosis, where it is needed at all, is a clinical judgement the score merely informs.

PHQ-9 scoring calculator

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Over the last two weeks, how often have you been bothered by any of the following problems?

1.Little interest or pleasure in doing things
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
2.Feeling down, depressed, or hopeless
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
3.Trouble falling or staying asleep, or sleeping too much
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
4.Feeling tired or having little energy
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
5.Poor appetite or overeating
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
6.Feeling bad about yourself, or that you are a failure, or have let yourself or your family down
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
7.Trouble concentrating on things, such as reading the newspaper or watching television
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
8.Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
9.Thoughts that you would be better off dead, or of hurting yourself in some way
Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)

0 of 9 items answered

PHQ-9 and GAD-7 developed by Drs Robert L. Spitzer, Janet B. W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.

Using the PHQ-9 well

The PHQ-9 was developed by Robert Spitzer, Janet Williams, Kurt Kroenke and colleagues in the late 1990s as part of the Patient Health Questionnaire family, and it became the standard depression measure in UK services because it is short, free to use and sensitive to change. Nine items, each scored 0 to 3 over the last two weeks, giving a total from 0 to 27.

The bands are a shorthand, not a verdict. A score is a snapshot of symptom frequency over a fortnight; it moves with sleep, physical illness, bereavement and shift work as well as with depression. Use the bands to discuss current symptoms and changes between administrations.

In NHS Talking Therapies, a score of 10 or more counts as above caseness and a change of 6 or more counts as reliable. Repeated measurement helps you discuss changes and review the work.

A falling score is not the same as a good outcome. Scores fall when people avoid what hurts, and rise when therapy touches something real; item 9 needs your attention every single time it is scored above zero. The measure informs clinical judgement and never replaces it.

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