Mood Check (PHQ-9)

What the PHQ-9 Is

The Patient Health Questionnaire-9 (PHQ-9) is the nine-item depression section of the Patient Health Questionnaire, a self-administered version of an earlier primary care tool called the PRIME-MD. It was developed by Kurt Kroenke, Robert Spitzer, and Janet Williams, and its main validation study was published in 2001 (Kroenke et al., 2001). The PHQ family of measures was developed with an educational grant from Pfizer Inc. and is in the public domain, so no permission is needed to use it (PHQ Screeners, n.d.).

What It Measures

The nine items match the nine symptom criteria for major depression in the DSM-IV (Kroenke et al., 2001). They ask about little interest or pleasure in doing things; feeling down or hopeless; sleep problems; tiredness or low energy; changes in appetite; feeling bad about yourself; trouble concentrating; moving or speaking slowly, or feeling unusually restless; and thoughts that you would be better off dead or of hurting yourself. A final question, which is not scored, asks how much these problems have made it hard to work, take care of things at home, or get along with other people (PHQ Screeners, n.d.).

How the Self-Check Works

Time Frame and Response Scale

Each item asks how often you have been bothered by a problem over the last 2 weeks: 0 (not at all), 1 (several days), 2 (more than half the days), or 3 (nearly every day) (PHQ Screeners, n.d.). Most people finish in a few minutes.

Scoring and Severity Bands

The total score ranges from 0 to 27. Scores of 5, 10, 15, and 20 mark the starting points for mild, moderate, moderately severe, and severe levels of depressive symptoms (Kroenke et al., 2001; PHQ Screeners, n.d.). In practice, that means 0–4 is minimal, 5–9 is mild, 10–14 is moderate, 15–19 is moderately severe, and 20–27 is severe. A score of 10 or higher is the most commonly cited cutoff (Levis et al., 2019; Manea et al., 2012), and it is a good point at which to set up a follow-up conversation with a qualified professional.

A Special Note on Question 9

Question 9 asks about thoughts of being better off dead or of hurting yourself. Any answer other than not at all deserves attention right away, no matter what your total score is. The PHQ-9's developers note that a final judgment about the risk of self-harm requires a conversation with a clinician (PHQ Screeners, n.d.). On our site, any answer above zero on this question brings up crisis resources immediately.

What the Research Shows

In the original study of 6,000 patients in primary care and obstetrics-gynecology clinics, a score of 10 or higher correctly identified 88% of people with major depression and correctly ruled out 88% of people without it, when compared with an interview by a mental health professional. Higher scores were also linked with poorer day-to-day functioning, more sick days, and more health care visits (Kroenke et al., 2001).

Larger reviews have confirmed these findings. A meta-analysis of 18 studies (n = 7,180) found acceptable accuracy across cutoff scores from 8 to 11 (Manea et al., 2012). An even larger analysis that pooled individual data from 58 studies (n = 17,357) found that a cutoff of 10 or higher gave the best overall balance of accuracy, with about 88% sensitivity and 85% specificity when compared with semistructured interviews (Levis et al., 2019).

The PHQ-9 has also been studied in the communities we serve. In help-seeking samples of first responders (N = 390) and veterans served outside the VA and Department of Defense (N = 493), the PHQ-9 held together well and was best described by two related parts: a thinking-and-feeling side and a physical side (Ahmadi, Galusha, et al., 2023; Ahmadi, Ponder, et al., 2023).

Limitations

This self-check is a screening self-check, not a diagnosis. The PHQ-9's own instructions explain that other possible causes, such as recent grief, a physical illness, a medication, or a history of very high mood episodes, have to be considered by a professional before a score can be fully understood (PHQ Screeners, n.d.). Some items, such as sleep, energy, and appetite, can also be affected by injuries, pain, or shift work. Accuracy also varies depending on how a study defines depression and who is being screened (Levis et al., 2019; Manea et al., 2012). Please discuss your results with a qualified professional, especially if your score is 10 or higher or if you answered anything above zero on Question 9.

How Healing the Hero Uses This Self-Check

Healing the Hero USA offers this self-check free of charge to veterans, first responders, corrections officers, Gold Star Families, Families of the Fallen, and the people who love them. It is confidential. Your answers are scored right on the page, and your results stay private unless you choose to share them with us. If you do choose to share, a Healing the Hero coach will connect with you within 24 hours to talk through what you are noticing and to help you find peer support or a qualified professional who fits your needs. You never have to explain yourself to a stranger first, and you are never obligated to take a next step you are not ready for.