The Patient Health Questionnaire (PHQ-9) is a self-administered depression screening tool that helps identify the presence and severity of depression symptoms. Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, and Kurt Kroenke, it has become one of the most widely used depression screening tools in clinical practice. By answering 9 simple questions, you can understand your depression level and receive appropriate recommendations.
Patient Health Questionnaire (PHQ-9)
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Over the last 2 weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things
Not at all
Several days
More than half the days
Nearly every day
Feeling down, depressed, or hopeless
Not at all
Several days
More than half the days
Nearly every day
Trouble falling or staying asleep, or sleeping too much
Not at all
Several days
More than half the days
Nearly every day
Feeling tired or having little energy
Not at all
Several days
More than half the days
Nearly every day
Poor appetite or overeating
Not at all
Several days
More than half the days
Nearly every day
Feeling bad about yourself - or that you are a failure or have let yourself or your family down
Not at all
Several days
More than half the days
Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television
Not at all
Several days
More than half the days
Nearly every day
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
Several days
More than half the days
Nearly every day
Thoughts that you would be better off dead or of hurting yourself in some way
Not at all
Several days
More than half the days
Nearly every day
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What is Major Depressive Disorder (MDD)?
Major Depressive Disorder (MDD), commonly known as clinical depression, is a serious mood disorder characterized by persistent feelings of sadness, hopelessness, and a loss of interest in activities once enjoyed. It affects how a person feels, thinks, and behaves, and can lead to various emotional and physical problems.
Depression is more than just feeling sad or going through a rough patch. It's a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families.
Development and Validation of the PHQ-9
The PHQ-9 was developed in the early 2000s as part of the Primary Care Evaluation of Mental Disorders (PRIME-MD) patient health questionnaire. It was designed to be a practical tool for clinicians to use in primary care settings to screen for depression.
The questionnaire has been extensively validated in numerous studies across different populations and settings. It has shown excellent reliability, validity, sensitivity, and specificity in detecting depression and assessing its severity.
Common Symptoms of Depression
Persistent sad, anxious, or "empty" mood
Loss of interest or pleasure in hobbies and activities
Decreased energy, fatigue, or feeling "slowed down"
Difficulty sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Restlessness or irritability
Difficulty concentrating, remembering, or making decisions
Persistent physical symptoms that do not respond to treatment
How to Interpret PHQ-9 Scores
The total score range for the PHQ-9 is 0-27 points, with higher scores indicating more severe depression symptoms. According to research, scores can be interpreted as follows:
0-4 points: Minimal or no depression
5-9 points: Mild depression
10-14 points: Moderate depression
15-19 points: Moderately severe depression
20-27 points: Severe depression
Strategies for Managing Depression
Lifestyle Adjustments
Regular physical activity: Exercise can increase endorphins and improve mood
Healthy diet: Proper nutrition can support brain health
Adequate sleep: Establish a regular sleep schedule
Stress management: Practice relaxation techniques such as deep breathing, meditation, or yoga
Social connection: Maintain relationships with supportive friends and family
Limit alcohol and avoid drugs: These substances can worsen depression symptoms
Psychological Therapy
Cognitive Behavioral Therapy (CBT): Helps identify and change negative thought patterns
Interpersonal Therapy (IPT): Focuses on improving relationships and social functioning
Problem-Solving Therapy: Teaches practical skills to cope with stressful life experiences
Mindfulness-Based Cognitive Therapy: Combines mindfulness practices with cognitive therapy
Medication
Under a doctor's guidance, certain medications may help manage depression symptoms, including:
It's important to seek professional help if you experience any of the following:
Symptoms of depression that last for more than two weeks
Depression that interferes with your daily functioning
Thoughts of harming yourself or others
Inability to care for yourself or perform basic daily tasks
Symptoms that don't improve with self-help strategies
Depression in Different Populations
Depression in Children and Adolescents
Depression can affect children and teenagers differently than adults. Signs may include:
Irritability or anger rather than sadness
Physical complaints like stomachaches or headaches
Social withdrawal or poor school performance
Extreme sensitivity to rejection or failure
Depression in Older Adults
Older adults may experience depression differently, with symptoms such as:
Memory difficulties or personality changes
Physical aches and pains
Fatigue, loss of appetite, or sleep problems
Less interest in socializing or hobbies
Important Note: This test is for reference only and cannot replace professional medical diagnosis. If you have severe depression symptoms, please consult a healthcare professional.
References
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613. DOI: 10.1046/j.1525-1497.2001.016009606.x
Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ, 365, l1476. DOI: 10.1136/bmj.l1476
Manea, L., Gilbody, S., & McMillan, D. (2012). Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ, 184(3), E191-E196. DOI: 10.1503/cmaj.110829
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.