PHQ-9 is a 9-question depression screener developed by Drs. Kurt Kroenke, Robert Spitzer, and Janet Williams in 2001. Each item is scored 0–3 over a 2-week recall period. Total range 0–27. Bands: 0–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe. PHQ-9 carries a B-grade USPSTF recommendation for primary-care depression screening (June 2023). It is a screening, not a diagnosis — only a licensed clinician can diagnose major depressive disorder using DSM-5 criteria.
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Over the last 2 weeks, how often have you been bothered by any of the following problems?
Your answer to question 9 indicates thoughts of being better off dead or of hurting yourself. Please reach out for support right now. You are not alone, and help is free, confidential, and immediate:
- Call or text 988 — Suicide & Crisis Lifeline (24/7, free, confidential)
- Text HOME to 741741 — Crisis Text Line (24/7)
- Call 911 — if you are in immediate danger
- Call SAMHSA 1-800-662-4357 — for substance-use plus mental-health concerns
A licensed clinician can also help today. PHQ-9 alone is not a suicide-risk assessment — please share your answer to question 9 with a clinician.
What the PHQ-9 measures and why USPSTF and SAMHSA endorse it
The PHQ-9 is a 9-item depression severity instrument developed by Drs. Kurt Kroenke, Robert L. Spitzer, and Janet B. W. Williams and published in 2001 in the Journal of General Internal Medicine. Each item maps directly to one of the nine DSM-5 symptom criteria for major depressive disorder. Validation in over 6,000 primary-care and obstetrics-gynecology patients showed sensitivity 88% and specificity 88% for major depression at the cutoff score of 10 (Kroenke et al. 2001). Subsequent meta-analyses across 50+ languages confirm consistent performance.
The US Preventive Services Task Force (June 2023) issued a B-grade recommendation for depression screening in adults — the most commonly used instrument is PHQ-9. PHQ-9 lives inside SAMHSA's SBIRT workflow alongside AUDIT and DAST as the standard depression screen for primary-care substance-use intersection.
The 9 items cover symptom domains: anhedonia (Q1, loss of interest), depressed mood (Q2), sleep disturbance (Q3), fatigue (Q4), appetite change (Q5), guilt or worthlessness (Q6), concentration difficulty (Q7), psychomotor change (Q8), and suicidal ideation (Q9). Each is scored 0–3 on a 2-week recall ("not at all" / "several days" / "more than half the days" / "nearly every day"). Total range is 0–27. Item 9 is a clinical-safety signal: any score above zero on this item warrants immediate clinical follow-up, separate from the total score.
PHQ-9 is © Pfizer Inc. and free to reproduce in any format with no permission needed per phqscreeners.com. It appears in the NIMH Mental Health Outcomes set, USPSTF evidence reviews, the Kaiser Permanente Mental Health Integration model, and most major US EHR systems for primary-care depression screening.
What the 5 score bands mean
PHQ-9 score interpretation comes directly from Kroenke et al.'s 2001 publication: 0–4 is "minimal or no depression," 5–9 is "mild," 10–14 is "moderate," 15–19 is "moderately severe," and 20–27 is "severe." Each band below explains what the score reflects clinically, what guidance the PHQ-9 authors attached to it, and how the band typically maps to depression treatment plus ASAM levels of care for co-occurring substance use disorder.
A PHQ-9 score of 0 to 4 reflects symptom levels unlikely to indicate depressive disorder for most adults. The instrument flagged none or very few of the nine DSM-5 symptom criteria as bothering you most days over the past two weeks. The instrument has documented sensitivity 88% and specificity 88% at cutoff 10, so a low score is a meaningful negative signal — but PHQ-9 is a screener, not a diagnosis. Brief sad moods after life events, normal grief, single-symptom sleep issues, and concerns specific to anxiety rather than depression can still warrant a clinical conversation. If a specific event prompted you to take this screener, consider mentioning it at your next primary-care visit even with a 0–4 score.
A PHQ-9 score of 5 to 9 indicates mild depressive symptoms below Kroenke's clinical-action threshold of 10. At this band the standard recommendation is watchful waiting plus re-screen in 2 to 4 weeks, with attention to sleep, exercise, social connection, and any escalating life stressors. SAMHSA's primary-care workflow typically triggers a brief educational conversation, sometimes called "advice" rather than full brief intervention. Behavioral activation and problem-solving therapy are evidence-based first-line approaches at this level. Consider an antidepressant medication consultation if symptoms persist beyond four weeks or begin affecting daily functioning. PHQ-9 re-screen monthly is recommended while symptoms continue.
A PHQ-9 score of 10 to 14 is consistent with moderate major depressive disorder by Kroenke's diagnostic framework as published in 2001. Active treatment is indicated — not watchful waiting. First-line evidence-based options are psychotherapy (CBT or interpersonal therapy) OR antidepressant medication, patient preference. SSRIs (sertraline, escitalopram, fluoxetine) are typically first choice and reach full effect over 4–6 weeks. For people with co-occurring substance use disorder, integrated dual-diagnosis treatment is recommended — addressing depression and substance use simultaneously, not sequentially — at ASAM Level 1.0 outpatient or Level 2.1 IOP (intensive outpatient). SAMHSA 1-800-662-4357 can route to integrated programs.
A PHQ-9 score of 15 to 19 indicates moderately severe depression that strongly warrants combined active treatment. Best evidence supports antidepressant medication plus psychotherapy together, not either alone. SSRIs remain first-line; titrate over 2–6 weeks and re-screen with PHQ-9 every 2–4 weeks during titration to track response. STAR*D trial data show ~33% remit on first SSRI, ~50% on second-line, ~67% with multiple-step approach. For co-occurring substance use disorder, ASAM Level 2.1 IOP or Level 2.5 PHP (partial hospitalization) is typically appropriate, with depression treatment integrated into the SUD program rather than referred out. A psychiatric consultation can help if first-line treatment has not produced response in 6–8 weeks.
A PHQ-9 score of 20 or higher indicates severe depression and triggers Kroenke's most urgent guidance. Immediate active treatment is indicated — antidepressant medication plus psychotherapy plus close monitoring, often coordinated by a psychiatrist or behavioral-health team. If you scored above zero on question 9 (thoughts of self-harm), please reach out today: call or text 988 for the Suicide & Crisis Lifeline, text HOME to 741741 for Crisis Text Line, or call 911 if in immediate danger. PHQ-9 alone is not a suicide-risk assessment — clinicians use the C-SSRS for risk stratification. For co-occurring substance use disorder, ASAM Level 2.5 PHP or higher is typically indicated, with consideration of inpatient psychiatric care if safety concerns are present.
From a PHQ-9 score to a real next step: 988 crisis line, primary care, and integrated treatment
If your PHQ-9 score is 10 or higher, Kroenke's guidance recommends active treatment; if your answer to question 9 is above zero, please reach out for immediate support regardless of total score. A PHQ-9 score alone is not a treatment plan but a structured, evidence-based starting point. Here is how the instrument's recommendations translate to concrete actions in the United States today.
If you scored above zero on question 9 (any score)
- Call or text 988 — the Suicide & Crisis Lifeline is free, confidential, and available 24/7 in English and Spanish. Text or call.
- Text HOME to 741741 — Crisis Text Line, 24/7, free.
- Call 911 — if you are in immediate danger.
- Tell a clinician today. PHQ-9 Q9 is the single best-validated brief screen for suicide risk; share your answer with your primary-care doctor or therapist as soon as possible.
If you scored 10 or higher (regardless of Q9)
- Talk to a primary-care clinician and bring your PHQ-9 score. PHQ-9 lives in primary-care SBIRT screening as the standard depression instrument that clinicians administer routinely; a 10+ score is a direct reason for longer conversation about treatment options including therapy and medication.
- Call SAMHSA's free 24/7 helpline at 1-800-662-4357. Counsellors provide information, insurance navigation, and warm transfers to local treatment for both mental-health and co-occurring substance-use concerns. Free, confidential, English and Spanish.
- Search SAMHSA's treatment locator by ZIP for behavioral-health providers, or browse our directory by state for integrated dual-diagnosis programs.
If you have co-occurring substance use
Depression co-occurs with substance use disorder in roughly 30 to 40 percent of cases (NESARC-III, Grant et al. 2016). Untreated depression doubles the post-treatment relapse rate (Hasin et al. 2018). Best evidence supports integrated treatment — addressing depression and substance use simultaneously, not sequentially:
- Single program for both: a treatment center that handles depression and SUD together (rather than referring depression out) is associated with substantially better outcomes. Ask explicitly about "dual-diagnosis" or "co-occurring disorders" capability when you call.
- Medications work for both: bupropion (Wellbutrin) is FDA-approved for depression and nicotine cessation; SSRIs improve depression without worsening SUD; naltrexone improves both alcohol use disorder and reduces depression in some patients (off-label).
- Therapy stacks: CBT for both depression and SUD; motivational interviewing for SUD ambivalence; behavioral activation for depression. A single therapist trained in both is ideal.
If PHQ-9 is not the right fit: GAD-7, AUDIT-10, DAST-10, and PHQ-2
PHQ-9 screens for depression severity over 2 weeks. If anxiety is your main concern, alcohol or drug use is a question, or you want a faster screen, the screeners below cover those distinct questions.
AUDIT-10 (Alcohol Use Disorders Identification Test)
10-question WHO-validated alcohol screener. Pair with PHQ-9 for a full alcohol-plus-depression picture — the combination is the standard primary-care SBIRT workflow.
DAST-10 (Drug Abuse Screening Test)
10-question Skinner-1982 drug-use screener (excluding alcohol and tobacco). Pair with PHQ-9 if substance use other than alcohol is a concern.
GAD-7 (Generalized Anxiety Disorder)
7-question anxiety severity screener (Spitzer 2006 — same author family as PHQ-9). Anxiety co-occurs with depression in roughly 50% of cases. At cutoff ≥10: 89% sensitivity, 82% specificity for GAD.
CAGE-4
4-question alcohol screener (Ewing JAMA 1984). Faster than AUDIT-10 but less sensitive. Public-domain. Cutoff ≥2 has 71% sensitivity / 90% specificity for AUD.
PHQ-2
2-item subset of PHQ-9 (anhedonia + depressed mood). Faster pre-screen used in primary care before triggering full PHQ-9.
ACE (Adverse Childhood Experiences)
10-question retrospective measure of childhood adversity (Felitti / CDC 1998). Public-domain. ACE ≥4 increases adult substance use disorder risk by 7×. Trauma-informed counterpart to current-symptom screeners.
PCL-5 (PTSD Checklist for DSM-5)
20-question current-symptom screener developed by VA National Center for PTSD (Weathers 2013). Public-domain. DSM-5-aligned with 4 cluster sub-scores. Pairs with ACE (past exposure + current symptoms = standard trauma workup). Cutoff ≥31 for probable PTSD.
WHO ASSIST
Longer 8-item WHO instrument covering alcohol, tobacco, cannabis, cocaine, stimulants, inhalants, sedatives, hallucinogens, opioids. For one-shot multi-substance screening. WHO ASSIST manual.
PHQ-9 terms: SSRI, DSM-5, SBIRT, ASAM, integrated treatment
Six terms appear repeatedly across this page — the instrument itself (PHQ-9), the most-prescribed depression medications (SSRIs), the diagnostic standard a clinician uses after the screen (DSM-5 MDD), the public-health workflow PHQ-9 fits inside (SBIRT), the level-of-care framework that maps to treatment intensity for co-occurring SUD (ASAM), and the evidence-based approach to depression-plus-SUD (integrated treatment). Plain definitions follow.
- PHQ-9
- Patient Health Questionnaire-9. Developed by Drs. Kurt Kroenke, Robert L. Spitzer, and Janet B. W. Williams and published in 2001. Scores 0–27 across 5 severity bands. Item 9 (suicidal ideation) is a clinical-safety signal independent of total score. © Pfizer Inc., free to reproduce with no permission needed.
- SSRI · Selective serotonin reuptake inhibitor
- First-line antidepressant medication class — sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa). Reach full clinical effect over 4–6 weeks. STAR*D trial (Trivedi 2006): ~33% remit on first SSRI, ~50% on second-line, ~67% with multi-step approach. For SUD context bupropion (Wellbutrin) is often preferred — FDA-approved for both depression and nicotine cessation.
- DSM-5 major depressive disorder
- 9 DSM-5 clinical criteria from the American Psychiatric Association: depressed mood, anhedonia, weight or appetite change, sleep disturbance, psychomotor change, fatigue, worthlessness/guilt, concentration difficulty, and suicidal ideation. ≥5 criteria over ≥2 weeks meets MDD threshold. PHQ-9's 9 items map directly to these criteria. PHQ-9 screens; DSM-5 diagnoses in clinical interview.
- SBIRT
- Screening, Brief Intervention, and Referral to Treatment — SAMHSA public-health workflow. PHQ-9 + AUDIT-10 + DAST-10 are the standard SBIRT screening trio for primary-care behavioral-health intersection. Brief intervention is a 5–15 minute structured conversation triggered at moderate-band scores.
- ASAM level of care
- The American Society of Addiction Medicine framework classifying treatment intensity from Level 0.5 through Level 4. Used for substance use disorder; depression treatment intensity often parallels (Level 1.0 outpatient ↔ moderate depression; Level 2.5 PHP ↔ moderately severe). See our treatment types index.
- Integrated treatment
- Best-evidence approach for depression plus co-occurring substance use disorder — addressing both diagnoses simultaneously in a single program rather than sequentially or in separate facilities. NIDA and SAMHSA recommend integrated dual-diagnosis programs over referring depression out. Outcomes: lower relapse, lower depression severity, lower drop-out.
PHQ-9 FAQ: anonymity, scoring, Q9 safety, alternatives, co-occurring SUD
Ten common questions about PHQ-9 — whether the quiz is truly anonymous, what specific scores mean clinically, how PHQ-9 differs from DSM-5 major depressive disorder diagnosis, what question 9 measures and how to handle a positive answer, when to use a different screener (GAD-7 for anxiety, AUDIT-10 for alcohol, DAST-10 for drugs), and how depression intersects with substance use disorder.
Is this PHQ-9 quiz anonymous?
Yes. Answers and scores are computed entirely in your browser. Nothing is sent to our servers. No email required. No account. No tracking of individual responses.
Is the PHQ-9 a diagnosis?
No. The PHQ-9 is a screening tool, not a diagnosis. A score of 10 or higher indicates symptoms worth discussing with a clinician. Only a licensed healthcare professional can diagnose major depressive disorder using DSM-5 criteria and a full clinical interview.
Who developed the PHQ-9?
Drs. Kurt Kroenke (Indiana University / Regenstrief Institute), Robert L. Spitzer (Columbia, lead architect of DSM-III/IV), and Janet B. W. Williams (Columbia) developed PHQ-9 as part of the PRIME-MD diagnostic suite. The original validation paper appeared in the Journal of General Internal Medicine 2001.
What should I do if I score 10 or higher?
A score of 10–14 is moderate, 15–19 is moderately severe, 20–27 is severe. At any score 10 or higher, talk with a clinician about treatment options including therapy and medication. SAMHSA at 1-800-662-4357 can route to local clinicians. Call or text 988 if you have any thoughts of harming yourself, or 911 if in immediate danger.
What does question 9 measure?
Question 9 asks about thoughts of being better off dead or hurting yourself. Any answer above zero on this item warrants immediate clinical follow-up, regardless of total score. Call or text 988 for the Suicide & Crisis Lifeline, text HOME to 741741 for Crisis Text Line, or call 911 if in immediate danger. PHQ-9 alone is not a suicide-risk assessment — clinicians use the Columbia Suicide Severity Rating Scale (C-SSRS) for risk stratification.
Can this quiz replace a clinical evaluation?
No. A clinician will use PHQ-9 results alongside a full clinical interview, medical history, and DSM-5 criteria. This screener is a useful starting point, not a substitute.
Is my data saved anywhere?
No. The quiz uses client-side JavaScript only. Questions and answers never leave the page. You can take a screenshot or print the page to share with a clinician, but nothing is stored on our servers.
How does PHQ-9 differ from DSM-5 major depressive disorder?
PHQ-9's 9 items map directly to the 9 DSM-5 symptom criteria for major depressive disorder. DSM-5 diagnosis additionally requires clinical interview, ≥2-week duration, assessment of functional impairment, and exclusion of bipolar disorder, substance-induced mood disorder, or medical-condition-induced depression. PHQ-9 flags; DSM-5 diagnoses in interview.
How does depression connect to substance use?
Depression co-occurs with substance use disorder in 30 to 40 percent of cases (NESARC-III, Grant et al. 2016). Untreated depression doubles post-treatment relapse rate (Hasin et al. 2018). Best evidence supports integrated treatment — depression and substance use addressed simultaneously, not sequentially. NIDA's research on comorbidity documents the evidence base. Call SAMHSA 1-800-662-4357 for integrated dual-diagnosis program referrals.
Is this the same PHQ-9 my primary-care doctor might use?
Yes, exactly the same 9 items with the same scoring. PHQ-9 lives inside the USPSTF 2023 depression-screening recommendation, the SAMHSA SBIRT toolkit, the Kaiser Permanente Mental Health Integration model, and most major US EHR systems. It is the most-used depression screen in US primary care.
PHQ-9 primary sources: Kroenke 2001, USPSTF, SAMHSA, NIMH, NIDA, Pfizer
Every fact and threshold on this page traces to one of the 10 sources below: Kroenke et al.'s 2001 publication in the Journal of General Internal Medicine, the USPSTF 2023 depression-screening recommendation, the SAMHSA helpline and SBIRT workflow, the NIMH depression reference, NIDA's research on comorbidity, ASAM's national practice guideline, and Pfizer's phqscreeners.com.
- Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
- USPSTF (2023). Depression and Suicide Risk in Adults: Screening — B-grade recommendation.
- 988 Suicide & Crisis Lifeline.
- SAMHSA National Helpline (1-800-662-4357).
- SAMHSA — Screening, Brief Intervention, and Referral to Treatment (SBIRT).
- NIMH — Depression (plain-language reference).
- NIDA — Comorbidity: Substance Use Disorders and Other Mental Illnesses.
- Pfizer / phqscreeners.com — PHQ-9 instrument library and reproduction permission.
- ASAM National Practice Guideline.
- SAMHSA treatment locator (findtreatment.gov).
reviewedBy schema appears in the structured data, and this notice stays visible. We do not provide medical advice and we do not replace evaluation by a licensed clinician. Medical emergency: 911. Crisis: call or text 988. Free, confidential substance-use guidance 24/7: SAMHSA 1-800-662-4357. Behavioral-health and substance-use treatment records are protected under 42 CFR Part 2 and HIPAA.
