Compliance and documentation

How to use the PHQ-9 to assess depression

A graphic pattern that repeats the abbreviated name of the assessment: "PHQ-9"

The Patient Health Questionnaire-9 helps screen for, diagnose, and track progress with depression.

One of the most important components of any treatment plan is an accurate diagnosis. Your education and clinical background can clue you in to what may be going on with a client, but in some cases, you may want or need to conduct a formal assessment before diagnosing someone.

The Patient Health Questionnaire-9, an assessment tool commonly used by therapists and other medical providers, helps screen for, diagnose, and track progress with depression. Below, learn more about the PHQ assessment and how you can incorporate it into your practice.

What is PHQ-9?

The PHQ-9, developed in 1999 and introduced to healthcare settings in 2001, assesses the presence and severity of depressive symptoms in adults 18 and older. The PHQ-9 has nine questions, all of which reflect items on the diagnostic criteria for major depressive disorder

It’s a self-administered assessment, which means the client fills it out on their own, marking the symptoms they’re experienced in the last two weeks and how frequently they’ve experienced them. Then, a medical provider scores the assessment based on the client’s answers. 

Evidence consistently shows the PHQ-9 has high reliability and specificity when screening for depression, making it one of the most effective evidence-based assessment tools. Because the PHQ-9 relies on a person’s self-reporting, it’s best used in conjunction with other clinical tools, such as a client interview.

PHQ 9 assessment

The PHQ-9 assessment includes the following questions and prompts clients to mark “not at all,” “several days,” “more than half the days,” or “nearly every day.”

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
  2. Feeling down, depressed, or hopeless
  3. Trouble falling or staying asleep, or sleeping too much
  4. Feeling tired or having little energy 
  5. Poor appetite or overeating
  6. Feeling bad about yourself or that you are a failure or have let yourself or your family down
  7. Trouble concentrating on things, such as reading the newspaper or watching television
  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
  9. Thoughts that you would be better off dead, or of hurting yourself

PHQ-9 scoring

Each measure on the assessment is measured on a three-point scale and assigned a certain number of points.

Nearly every day: 3 points

More than half the days: 2 points

Several days: 1 point

Not at all: 0 points

​​When each answer is assigned a point value, the total score for the PHQ-9 assessment can range from 0–27. In general, the higher the score, the more severe a person’s depression.

Score 0-4: No depression

Score 5-9: Mild depression

Score 10-14: Moderate depression

Score 15-19: Moderately severe depression

Score 20 or greater: Severe Anxiety

According to the American Psychological Association, major depression is diagnosed if five or more of the nine depressive symptom criteria have been present at least "more than half the days" in the past two weeks and one of the symptoms is depressed mood (also known as anhedonia).

Monitoring changes in PHQ-9

While it’s often used as a tool for screening and diagnosing depression in new clients, the PHQ-9 is also useful in re-assessing clients so you can adjust their treatment plan as needed. For example, if you diagnosed a client with depression six months ago, you can re-issue the PHQ-9 to determine the current severity of symptoms and adjust your treatment plan as needed. 

Headway is a free service that makes it easier and more profitable for therapists and psychiatrists to accept insurance.

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ICD-10 codes for depression

Here are some of the most common ICD-10 codes associated with depressive symptoms, with different criteria for frequency, severity, and other features.

ICD-10 codes for depression

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