Patient Health Questionnaire – Depression (PHQ-9)

Instructions:

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things 0 1 2 3
Feeling down, depressed, or hopeless 0 1 2 3
Trouble falling or staying asleep, or sleeping too much 0 1 2 3
Feeling tired or having little energy 0 1 2 3
Poor appetite or overeating 0 1 2 3
Feeling bad about yourself — or that you are a failure or have let yourself or your family down 0 1 2 3
Trouble concentrating on things, such as reading the newspaper or watching television 0 1 2 3
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 0 1 2 3
Thoughts that you would be better off dead or of hurting

yourself in some way

0 1 2 3

Description

The PHQ-9 is the nine-item depression subscale of the Patient Health Questionnaire and is a widely used tool for assisting primary care clinicians in diagnosing depression as well as monitoring treatment. The PHQ-9 is based directly on the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual Fourth Edition (DSM-IV).

Validity and Reliability

To establish reliability and validity the PHQ-9 was administered to 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics, and construct validity and criterion validity were assessed against independent measures (Kroenke, Spitzer and Williams 2001). Criterion validity was assessed against an independent structured mental health professional interview in a sample of 580 patients. The mean PHQ-9 score was 17.1 (SD, 6.1) in the 41 patients diagnosed as having major depression; 10.4 (SD, 5.4) in the 65 patients diagnosed as other depressive disorder; and 3.3 (SD, 3.8) in the 474 patients with no depressive disorder. A PHQ-9 score of more than 10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively.

Interpretation

A raw score (from 0 to 27) is presented, as well as a percentile based on sample of non-depressed individuals, a sample of those diagnosed with major depression, and sample diagnosed as having other depressive disorders. An individual with a percentile of around 50 compared to the major depression (MD) sample has a typical level of depression when compared to others diagnosed with major depression. The non-depressed percentile and the other-depressed percentile will be substantially higher. Conversely, an individual who scores in the 50th percentile compared to the non-depressed sample will likely score very low on the two depressed sample subscales.

Developer

Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues.

Number Of Questions

9

References

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ‐9. Journal of general internal medicine, 16(9), 606-613.

Developer Reference:

Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues.

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