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Scoring the PHQ-9
Depression severity is calculated by assigning scores of 0, 1, 2, and 3 to the response categories of 'not at all'; 'several days'; 'more than half the days' and 'nearly every day' respectively. The total score for the nine items scored ranges from 0 to 27.
'Major depressive syndrome' is likely if questions number '1' ('little interest or pleasure in doing things') or '2' ('feeling down, depressed, or hopeless') and five or more of questions '1' through '9' score at least '2' ('more than half the days'). Count question number '10' if answered.
'Other depressive syndrome' is likely if questions number '1' or '2' and two, three, or four of questions numbered '1' through '10' score at least '2' ('more than half the days'). Include question number '10' if answered. The sum of the first two questions is sometimes used as a rapid guide to the likely presence of depression. the 'PHQ-2' as this is called, gives a score on the range of zero to six. A score of three or more warrants further investigation.
A diagnosis cannot be made using the PHQ-9 alone; a professional clinical interview should consider the possibility of physical causes, drug use, any manic / hypomanic episodes and normal bereavement reactions.
||Possible Approaches (include user preference)
|00 – 04
||None or minimal
|05 – 09
||Active monitoring; lifestyle change, low-intensity therapy, self-help, peer support
|10 – 14
||Support, active monitoring, antidepressant or psychological therapy
|15 – 19
||Antidepressant and / or psychological therapy
|20 – 27
||Antidepressant and psychological therapy - consider collaborative management
Adapted from Kroenke, K., Spitzer, R.L., Psychiatric Annals 2002:32 p.509-521.
Copies of the PHQ family of measures are available from the PHQ Screeners website.
From the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ). The PHQ was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues. PRIME-MD is a trademark of Pfizer Inc. Copyright 1999 Pfizer Inc. All rights reserved.