IMPACT - Evidence-based depression care
IMPACT tools
PHQ-9

What is the PHQ-9?

The PHQ-9 is the nine item depression scale of the Patient Health Questionnaire*. It can be a powerful tool to assist clinicians with diagnosing depression and monitoring treatment response. The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV (Diagnostic and Statistical Manual Fourth Edition). This can help track a patients overall depression severity as well as the specific symptoms that are improving or not with treatment.

What is the PHQ-2?

Some clinicians and organizations use the first two items of the PHQ-9 as an initial depression screening. If the patient responds affirmatively to either of these two items, the remaining 7 items are asked. This can be an efficient way to screen large groups of patients to improve detection of undiagnosed depression.
Li, MM, Friedman, B, Conwell, Y, Fiscella, K. Validity of the Patient Health Questionnaire 2 (PGQ-2) in Identifying Major Depression in Older People. Journal of the American Geriatric Society. 2007; 55:596-602

Alternatives to the PHQ-9

Several depression screening instruments have been developed and validated for use in primary care and other settings. Instruments vary by whether they are self- or interviewer-reported and applicable to patients with cognitive or language barriers.

The Geriatric Depression Scale
This self-report instrument has been studied in multiple settings. There is a five-item version and a 15-item version of this measure. (The 15-item measure has excellent psychometric properties when compared to a structured diagnostic instrument in a sample of functionally impaired, cognitively intact, community-dwelling primary care patients.)

The Center for Epidemiologic Studies Depression Scale
This is one of the most common instruments applied in community studies and also used in primary care settings.

Cornell Scale for Depression in Dementia
This incorporates both observer and informant based information and is helpful in evaluating cognitively impaired patients for depression.

Advantages of the PHQ-9

This tool :

  • Is shorter than other depression rating scales,
  • Can be administered in person, by telephone, or self-administered,
  • Facilitates diagnosis of major depression,
  • Provides assessment of symptom severity,
  • Has proven effective in a geriatric population, (Löewe B,et al, 2004 Medical Care)
  • Is well validated and documented in a variety of populations

Scoring

Research has shown that certain scores on the PHQ-9 are strongly correlated with a subsequent major depression diagnosis. However, not everyone with an elevated PHQ-9 is certain to have major depression. The PHQ-9 is intended as a tool to assist clinicians with identifying and diagnosing depression but is not a substitute for diagnosis by a trained clinician.

view publications about the phq-9

Video Demonstration

The PHQ-9 can be self-administered or clinician- administered. These videos show a care manager administering the PHQ-9 to a primary care patient. At the initial visit for depression care the PHQ-9 is used to assist with diagnosis and identification of problem symptoms. At the follow-up visit, the PHQ-9 is used to measure treatment response and identify specific symptoms that are not responding.

Note: Videos can only be viewed with Real Player which can be downloaded free.

Learn more: view video of initial visit PHQ-9
Learn more: view video of follow-up PHQ-9

Available languages

The PHQ-9 Depression Screener is provided at http://www.phqscreeners.com/ in a variety of languages, including Arabic, Assamese, Chinese (Cantonese, Mandarin), Czech, Dutch, Danish, English, Finnish, French, French Canadian, German, Greek, Gujarati, Hindi, Hebrew, Hungarian, Italian, Malay, Malayalam, Norwegian, Oriya, Polish, Portuguese, Russian, Spanish, Swedish and Telugu.

*The PHQ-9 is adapted from PRIME MD TODAY®, developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke , and colleagues with an educational grant from Pfizer Inc. For research information, contact Dr. Spitzer at rls@columbia.edu. The names PRIME-MD® and PRIME MD TODAY® are trademarks of Pfizer, Inc.

PHQ © 1999 Pfizer Inc. All rights reserved. Reproduced with permission of Pfizer, Inc.

View selected peer-reviewed publications about the phq-9 Learn more: view video of initial visit PHQ-9 Learn more: view video of follow-up PHQ-9 Link to AIMS Center website