PHQ-9

PHQ-9 overview 

The Patient Health Questionnaire (PHQ-9) (1) is a nine item questionnaire used to assess symptoms associated with depression. Use of the tool will help you better understand the frequency, intensity and impact to functioning of any symptoms your client may be experiencing. By using the questionnaire and noting the results over time, you will be able to understand the patient's overall level of depressive symptoms, changes to their symptoms and the impact of those symptoms on their functioning, and whether self-reported symptoms may reach a significant impact. When considering a diagnosis, you will still need to use clinical interviewing skills to determine whether the symptoms are causing clinically significant distress or impairment, and whether those symptoms are not better explained or attributed to other conditions the client is experiencing.
 

Scoring 

0-3 item rating assessing presence of symptoms over the past 2 weeks

• 0= not at all
• 1= several days
• 2= more than half the days
• 3= nearly everyday 

Total score- 0-27 point scale 

• 0-4= no notable depressive symptoms
• 5-9= mild
• 10-14= moderate
• 15-19= moderately severe
• 20+= severe

Positive risk score (question 9)

1. Question 9: Thoughts that you would be better off dead or hurting yourself in some way
2. A score higher than 0 indicates that an individual has reported these thoughts at least some of the days
3. A response offers an opportunity to complete a clinical risk assessment, determine if further safety action needed, and develop a safety plan 

Treatment considerations based on score: (2)

Measuring change

Determining clinically significant change is done by exhibiting a person moved from a depressed range (scores greater than or equal to 10) pre-treatment to a non-depressed range (scores less than or equal to 9) post-treatment. Improvement in scores should be 50% or greater of the patients’ pretreatment score; a 5 point or more change in scores indicates reliable change.

Potential interventions based on individual PHQ items

1. Clinicians may also find it helpful to consider treatment interventions and focus based on elevated responses to specific symptom categories 
2. Some possible intervention, tools and considerations (3)

SonderMind’s guidelines for providers

As a mental health professional, client care decisions are up to your discretion. However, we recommend attention to the following scenarios related to PHQ-9:

A positive score for question 9: “Thoughts that you are better off dead or of hurting yourself in some way”:

• Complete a thorough risk assessment, develop a safety plan and take appropriate clinical action.

A total score of 20+ which indicates severe symptoms. 

• Discussion with your client about their score, development of a treatment plan to address these concerns, as well as consideration for other support resources that might be clinically appropriate. Safety and treatment plan are adjusted as necessary. 

An increased change in score by 10+ points

• Discussion with your client about the change in their score.
• Collaborative discussion of current treatment plan with consideration of what adjustments might be needed.
• Evaluation of alternative or additional professional services might be needed.