PHQ-9 is a brief 9-item self-report questionnaire that measures the severity of depressive symptoms over the past 2 weeks. Each item is scored from 0 to 3, giving a total between 0 and 27: 0–4 is minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, and 20–27 severe. It's a tool for screening and tracking change over time, not a diagnosis. Any non-zero response to item 9 calls for a separate conversation about risk, regardless of the total score.
What is PHQ-9 and where did it come from?
PHQ-9 (Patient Health Questionnaire-9) is part of the Patient Health Questionnaire developed by Kurt Kroenke, Robert Spitzer, and Janet Williams for primary care. Its nine items map onto the nine DSM criteria for a depressive episode — from low mood and loss of interest to thoughts of death. The questionnaire is freely available and has been translated into many languages, including Ukrainian.
Psychologists and psychotherapists use PHQ-9 for three purposes: initial screening, assessing symptom severity, and repeated measurement throughout therapy to see how a client's state is changing.
What are the 9 items of PHQ-9?
The client answers the question: “Over the past 2 weeks, how often have you been bothered by the following?” The items, in the order they appear in the questionnaire:
- Little interest or pleasure in doing things.
- Feeling down, depressed, or hopeless.
- Trouble falling asleep, broken sleep, or sleeping too much.
- Feeling tired or having little energy.
- Poor appetite or overeating.
- Negative thoughts about yourself — feeling that you are a failure, that you've let yourself down, or that you've let your family down.
- Trouble concentrating — for example, on reading or watching shows.
- Moving or speaking so slowly that others could notice, or the opposite — being restless and fidgety.
- Thoughts that you would be better off dead, or thoughts of hurting yourself in some way.
After the nine items comes a separate question about impact: how much these problems have made it difficult to work, take care of things at home, or get along with people. The options range from “not difficult at all” to “extremely difficult.” This question is not part of the total score, but it shows how the symptoms are affecting the client's life.
How do you score PHQ-9?
Each item has four answer options with a fixed number of points:
- 0 — not at all;
- 1 — several days;
- 2 — more than half the days;
- 3 — nearly every day.
The total score is simply the sum of the nine answers, from 0 to 27. PHQ-9 has no reverse-scored items: the higher the score, the more pronounced the symptoms.
How do you interpret the result?
The commonly used severity ranges for depressive symptoms are:
- 0–4 — minimal;
- 5–9 — mild;
- 10–14 — moderate;
- 15–19 — moderately severe;
- 20–27 — severe.
A score of 10 or above is often used as a threshold beyond which it's worth assessing the client's state more closely. But a range isn't a conclusion. Two clients with the same score of 12 can present very differently: one struggling mainly with sleep, fatigue, and appetite, the other with loss of interest, guilt, and thoughts of death. So beyond the total, look at the pattern of item-by-item answers and at the question about impact on daily life.
What to check after scoring
- The answer to item 9 — whether it's zero.
- Items 1 and 2 — loss of interest and low mood. These are the core features of a depressive episode in the DSM, so it matters whether at least one of them is present.
- Items answered “nearly every day” — a convenient place to start the conversation.
- The question about impact on work, home, and relationships.
- Whether sleep, appetite, and fatigue might have a physical cause worth asking about.
Item 9: what to watch for
Item 9 asks about thoughts of death or self-harm. Any answer other than “not at all” calls for direct exploration of risk — even when the total score is low. The item itself only speaks to how often such thoughts occur; it says nothing about intent, a plan, access to means, or previous attempts. Those can only be clarified in conversation.
When should you give PHQ-9 to a client?
- At the start of therapy, if the presenting concern involves low mood, loss of interest, fatigue, or sleep problems.
- When a client's state has changed noticeably or new complaints have appeared.
- For repeated measurement throughout therapy — to track change rather than rely on overall impression alone. Since the questionnaire covers the past 2 weeks, there's no point in repeating it more often.
Limitations of PHQ-9
- It's a self-report. A client may understate or overstate symptoms — out of shame, fear of judgment, or a wish to be heard.
- Physical symptoms are non-specific. Sleep, appetite, fatigue, and concentration can be affected by medical conditions, pregnancy, medication, chronic stress, or sleep loss from other causes.
- It doesn't distinguish between types of depressive states. PHQ-9 doesn't detect episodes of elevated mood, so it won't tell depression within bipolar disorder apart from other conditions.
- It's a two-week snapshot. The questionnaire doesn't show how long the state has lasted or what preceded it.
How do you discuss the result with a client?
It's better not just to report the PHQ-9 result but to review it together. Start with what the client themselves noticed while filling it out, then move on to the items with the highest scores.
You noted that you feel tired nearly every day and that it's hard to concentrate. Can you tell me what that looks like on an ordinary day? And of the things you marked, which one troubles you the most?
When measuring again, it helps to compare not only the total score but individual items too: sleep or energy often shift first, while how a person feels about themselves changes later.
How do you explain to a client why this questionnaire?
A client who receives the form without any explanation may see it as an exam or a way to “pin a label” on them. A few sentences before sending it ease that anxiety and make the answers more honest.
I'll send you a short questionnaire — it takes a few minutes. It'll help us see more clearly how you've been feeling over the past two weeks. It's not a diagnosis and not a test you can pass or fail. Answer as things really are, and we'll discuss the result together at our next meeting.
Common mistakes when using PHQ-9
- Telling the client “you have moderate depression”
- Looking only at the total score
- Overlooking a “1” on item 9 because the total is low
- Giving the questionnaire once and forgetting about it
- Comparing results collected with different instructions
- Talking about symptom severity and discussing it together
- Reviewing the item pattern and the question about impact on life
- Exploring any non-zero response to item 9
- Repeating the measurement and comparing individual items
- Using the same version and the same instructions every time
PHQ-9 and GAD-7: why they're often given together
Depressive and anxious symptoms often go hand in hand, and some of them overlap: irritability, restlessness, trouble concentrating, and sleep problems. That's why PHQ-9 is frequently paired with the GAD-7 anxiety scale — both are brief, share the same answer format, and together take only a few minutes. Seeing the two results side by side helps reveal what predominates in the client's state and frame the focus of the work more precisely.
How PHQ-9 works in Praxis
PHQ-9 is found under “Additional assignments for the client” → “Diagnostic tools”, in the “Current state” category. The tool's page includes a description for the therapist: when to use it, what it measures, and what to pay attention to. The “Send to a client” button opens the client selection.
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The client fills it out in their own portal
They see the tool marked with a bell, answer the questions, and click “Save and send for review”. It can be answered only once.
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You receive a notification
A message appears in the bell at the top of your portal, and the answers are also available in block “3. Additional assignments for the client” on the client's page.
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The result is scored automatically
The “Summary (scores, scales, other)” tab shows the total score with its severity range, impact on daily life, and the item-by-item answers. “Filled in only” displays the questions and answers in words, while “As a questionnaire” shows the form as the client saw it.
If the client flagged item 9, a red warning appears in the “Summary,” asking you to assess risk at the next contact. Only you see this warning: the client reads their results in the same tabs, but without the notes for the therapist. To repeat the measurement, you can send the tool again — each completion appears separately in the client's list of assignments.
