The PHQ-9 in one page: nine items to screen for depression and grade severity, scoring, the 5-10-15-20 cut-offs with their source, license and citation.
Nine items, one for each DSM-IV criterion for a major depressive episode, used both to screen for depression and to grade the severity of symptoms over the last two weeks. Free to use, with a validated Spanish version.
By Víctor Ciudad-Fernández, PhD · Updated: October 6, 2026 · Leer esta ficha en español · Instruments
The PHQ-9 is the depression module of the Patient Health Questionnaire, the self-administered version of PRIME-MD, a system for diagnosing the most common mental disorders in primary care. Its nine items map onto the nine DSM-IV criteria for a major depressive episode, and each asks how often that problem has bothered you over the last two weeks.
It has two uses. As a severity measure, the 0 to 27 total grades symptoms and tracks change over time. As a diagnostic aid, it also supports an algorithm based on DSM-IV criteria. Being brief, it is used in primary care, as an outcome in clinical trials and in epidemiological research.
It does not replace a clinical interview: it is a screening and monitoring tool. A high score means an assessment is warranted, not that a disorder is present.
Each item is scored from 0 (not at all) to 3 (nearly every day) according to frequency over the last two weeks, and the total is the sum of the nine items, from 0 to 27. There are no reverse-keyed items. The form ends with a question on how difficult these problems have made work, home tasks or getting along with others, which is not part of the total.
Item 9 asks about thoughts of death or self-harm. If you use it in research, write down in your protocol, before you start, what you will do when someone scores it above 0: your ethics committee will ask.
The PHQ-9 was designed as a single-score severity measure tied to diagnostic criteria, not as a scale with subdimensions. In the original validation the score behaved as such: higher scores came with worse functioning on all six SF-20 scales, more sick days, more symptom-related difficulty and more clinic visits, with similar results in primary care and obstetrics-gynecology.
Positive likelihood ratios for major depression rise step by step with each score band: 0.04 (0-4), 0.5 (5-9), 2.6 (10-14), 8.4 (15-19) and 36.8 (20-27). In other words, a score of 20 or more is about 37 times more likely in a person with major depression than in one without it.
The authors chose the 5, 10, 15 and 20 cut points for two reasons they explain in the paper: they are easy for clinicians to remember and apply, and using different cut points did not noticeably change the association between severity and the validity measures.
| Score | Severity | Source |
|---|---|---|
| 0-4 | Minimal | Kroenke et al. (2001) |
| 5-9 | Mild | Kroenke et al. (2001) |
| 10-14 | Moderate | Kroenke et al. (2001) |
| 15-19 | Moderately severe | Kroenke et al. (2001) |
| 20-27 | Severe | Kroenke et al. (2001) |
| ≥10 | Screening for major depression: 88% sensitivity and specificity | Kroenke et al. (2001) |
| ≥12 | Better balance as a screen in Spanish primary care | Muñoz-Navarro et al. (2017) |
In Spanish primary care, the cut-off of 10 caught 95% of cases but with many false positives (specificity .67); 12 gave a better balance. The right cut-off depends on your population and on what you use it for.
A screening questionnaire is not a diagnosis: a high score means a clinical assessment is warranted, not that a disorder is present.
Diez-Quevedo et al. (2001) validated the Spanish version of the full PHQ with 1,003 inpatients at a Spanish general hospital, randomly selected from all admissions over 18 months: agreement with a mental health professional was comparable to that of the original version in primary care, and the questionnaire’s depression severity index correlated with the number of symptoms found at interview and with the Beck Depression Inventory.
For the PHQ-9 in Spanish primary care, the reference study is Muñoz-Navarro et al. (2017), within the PsicAP trial: 178 patients, with the SCID-I as the criterion. The authors conclude that the PHQ-9 is a highly satisfactory tool to screen for major depression in that setting, performing better with a cut-off of 12 than with the standard 10.
License: Free to use. The footer of the official forms says it explicitly: no permission is required to reproduce, translate, display or distribute it. It was developed by Spitzer, Williams, Kroenke and colleagues with an educational grant from Pfizer.
The official forms are downloaded from the PHQ screeners website. Although no permission is needed, a publication must cite the original paper and the language version you used.
Cite the original paper and, if you use the Spanish version in primary care, its validation:
@article{kroenke2001phq9,
author = {Kroenke, Kurt and Spitzer, Robert L. and Williams, Janet B. W.},
title = {The {PHQ-9}: Validity of a brief depression severity measure},
journal = {Journal of General Internal Medicine},
year = {2001},
volume = {16},
number = {9},
pages = {606--613},
doi = {10.1046/j.1525-1497.2001.016009606.x}
}If you validate the PHQ-9 against a clinical interview in your own sample, or compare the 10 and 12 cut-offs, what you need to report is a two-by-two table for each cut-off. The sensitivity and specificity calculator gives you sensitivity, specificity, predictive values and likelihood ratios with their confidence intervals.
Ten is the standard from the original paper (88% sensitivity and specificity against interview in US primary care). In Spanish primary care, Muñoz-Navarro et al. (2017) found a better balance at 12. For screening, where you do not want to miss cases, the more sensitive cut-off is usually preferred; for prevalence estimates, the more balanced one. Justify your choice with the reference.
No. The official forms state that no permission is required to reproduce, translate, display or distribute it. You do need to cite the source in your work.
This fact sheet is an academic reference for information purposes: it does not reproduce any questionnaire item. Using the instrument in your research or practice may require citing its authors or asking for permission: see “How to get the instrument”.