A PHQ-9 score is a number between 0 and 27 that reflects how many symptoms of depression you’ve experienced over the past two weeks, and how often. It comes from a nine-item questionnaire widely used in primary care, therapy offices, and mental health clinics to screen for depression. A score of 10 or higher is the standard threshold that signals possible major depression.
How the PHQ-9 Is Scored
The questionnaire asks about nine specific problems and how frequently they’ve bothered you in the last two weeks. For each item, you choose one of four responses:
- Not at all = 0 points
- Several days = 1 point
- More than half the days = 2 points
- Nearly every day = 3 points
Your total score is the sum of all nine items. Because each item maxes out at 3, the highest possible score is 27. The lowest is 0.
What the Nine Questions Cover
Each question maps to a core symptom of depression. The nine items ask about:
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself, or that you are a failure or have let yourself or your family down
- Trouble concentrating on things, such as reading or watching television
- Moving or speaking noticeably slowly, or the opposite: being so fidgety or restless that you’ve been moving around more than usual
- Thoughts that you would be better off dead or of hurting yourself in some way
These nine symptoms are the same criteria clinicians use to diagnose major depressive disorder. The PHQ-9 doesn’t diagnose depression on its own, but it captures the same picture in a structured, measurable way.
What Each Score Range Means
The American Psychiatric Association breaks PHQ-9 scores into five severity levels:
- 0 to 4: None to minimal. Few or no depressive symptoms. No clinical action is typically needed.
- 5 to 9: Mild depression. Some symptoms are present but may not significantly impair daily life. The usual approach is to monitor and reassess at a follow-up visit.
- 10 to 14: Moderate depression. Symptoms are frequent enough to affect functioning. This is the range where a provider will often discuss a treatment plan, which could include counseling, medication, or both.
- 15 to 19: Moderately severe depression. Symptoms are common and disruptive. Active treatment with therapy, medication, or a combination is generally recommended.
- 20 to 27: Severe depression. Symptoms are pervasive and significantly impairing. This range typically prompts referral to a mental health specialist if one isn’t already involved.
Why 10 Is the Key Cutoff
A score of 10 or above is the most commonly used threshold for identifying possible major depression. A large meta-analysis found that at this cutoff, the PHQ-9 correctly identifies about 88% of people who have major depression and correctly rules it out in about 86% of people who don’t. That combination of sensitivity and specificity is strong for a screening tool, which is why 10 is the number most providers use as a decision point.
It’s worth understanding what “screening” means here. A score of 12 doesn’t mean you definitely have major depression, and a score of 8 doesn’t mean you definitely don’t. The PHQ-9 flags who needs a closer look. Your provider uses the score alongside a conversation about your symptoms, history, and daily functioning to determine whether a depression diagnosis fits.
Question 9 and Suicide Risk
The ninth item, about thoughts of being better off dead or hurting yourself, carries special weight regardless of your total score. Any non-zero answer on this question prompts further assessment. Even if your overall score is low, endorsing this item means a provider will ask follow-up questions to understand the nature of those thoughts, how frequent they are, and whether you have a plan or intent. This isn’t meant to alarm you. It’s a safety step built into the tool’s design.
How Your Score Is Used Over Time
The PHQ-9 isn’t a one-time test. Providers often repeat it at follow-up appointments to track whether symptoms are improving, stable, or getting worse. A drop of 5 or more points from one visit to the next is generally considered a meaningful improvement. This makes it useful not just for initial screening but for monitoring how well a treatment is working.
The U.S. Preventive Services Task Force recommends screening all adults for depression but hasn’t identified an ideal frequency. In practice, providers use clinical judgment: you might complete it at an annual physical, at the start of therapy, or more frequently if you’re being treated for depression and your provider wants to gauge progress.
What a PHQ-9 Score Can and Can’t Tell You
The PHQ-9 captures symptom frequency over a two-week window. It’s good at quantifying how often you’re experiencing specific problems, and it gives you and your provider a shared number to work from. That’s genuinely useful. Depression can feel vague and hard to describe, and having a concrete score can make it easier to communicate what you’re going through.
What it can’t do is explain why you feel that way. Sleep problems, low energy, and poor concentration can stem from medical conditions, medication side effects, grief, stress, or a dozen other causes. A high PHQ-9 score is the starting point for a conversation, not the end of one. If you’ve taken the PHQ-9 on your own and scored 10 or above, bringing that result to a provider gives them a useful head start on understanding where you are.