How To Score the Patient Health Questionnaire (PHQ-9)

In addition to serving as the primary diagnostic tool, the PHQ-9 can be used to measure the severity of depression and monitor the patient’s response to treatment. The team member administering the tool may vary (for example, the primary care physician, the office staff or the care planner) depending on what the tool is being used for.

To diagnose depression, item 1 or item 2 on the PHQ-9 must be present more than half the days or nearly every day. These two items are based on the two-question screen, and they provide the first indication that a patient may be depressed.

In addition, for depression to be present, the patient must answer item 10 as “somewhat difficult,” “very difficult” or “extremely difficult.”

To calculate the “symptom score,” total the number of boxes checked in the blue shaded region below. Use this score, along with the “severity score” (see below), to make a diagnosis and determine appropriate treatment.

Of course, the PHQ-9 is merely one tool for diagnosing and managing depression. Patients should never be diagnosed solely on the basis of a PHQ-9 score. The primary care physician will use clinical expertise to determine whether depression is present. Additional clinical considerations may affect decisions about management and treatment.

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To determine the severity of a patient's depression (the severity score), count 1 point for each item checked “several days,” count 2 points for each item checked “more than half the days” and count 3 points for each item checked “nearly every day.” The severity score is the total of all items. (Ignore items checked “not at all.”)

With possible scores ranging from 0 to 27, a higher score means more severe depression. Use the severity score and the symptom score to determine appropriate treatment.

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Aetna Depression Management endorses the use of the PHQ-9 throughout treatment to assess the patient’s response. In Aetna Depression Management, the primary care office will administer the first PHQ-9. In general, the care planner administers the PHQ-9 after referral, at weeks 4 and 8.

The goal of acute-phase treatment is a PHQ-9 severity score of less than 5, which indicates a remission of symptoms. Patients who achieve this goal enter into the continuation phase of treatment. Patients who do not achieve this goal remain in acute phase treatment with some alteration in treatment (for example, dose increase, change in medication). Patients who do not achieve remission after two adequate trials of antidepressant medications and/or psychological counseling or by 20 to 30 weeks should have a psychiatric consultation for diagnostic and management suggestions.

For more details about how to use the PHQ-9 to assess a patient’s response to treatment, take our continuing education course, where you will find all the documents you need to apply this tool in your practice.

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These guidelines are not intended to be exhaustive, nor are they intended to be prescriptive or replace your own independent medical judgment.