Patient Health Questionnaire-9 (PHQ-9)

Download Clinical Summary PDF

Tool Description

  • 9 item screening measure devised to identify probable major depressive disorder (MDD) among adult primary care patients.

ICF Domain:

Body Function – Subcategory: Mental Functions.

Number of Items:

9

Brief Instructions for Administration & Scoring

Administration:

  • Self report; can also be done in interview format.
  • Items are rated in terms of how persistent the symptoms have been in the past 2 weeks: 0 – not at all, 1 – several days, 2 – more than half of the days, 3 – nearly every day.
  • Administration time is approximately 5 minutes.

Equipment:None.

Scoring:

  • Score for each individual item is summed to produce a total score.

Interpretability

MCID: not established for the SCI population, but for a sample of older primary care patients (n = 434, mean age = 71 (7.4) years, all participants enrolled in the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT)):

MCID = 5 points

Reference: Lowe, B., Unutzer, J., et al. (2004). "Monitoring depression treatment outcomes with the patient health questionnaire-9." Med Care 42(12): 1194-1201.

SEM: not established for the SCI population, but for a sample of older primary care patients (see Lowe et al. 2004 reference above): SEM for change due to treatment and no control of prior depression = 2.44 SEM for the same number of DSM-IV depressive symptoms at both assessments = 1.32

MDC: not established

  • Higher scores indicate increased severity of depression
  • A cut-off score of 10 has been reported to indicate major depression.
  • Published data for the SCI population is available for comparison (see the Interpretability section of the Study Details sheet).

Languages:

English and Spanish versions available

Training Required:

None.

Availability:

Measure available online in PDF format Copyright © Pfizer Inc. after agreeing to several conditions including use for research, in clinical programs or physician education (http://www.pfizer.com/pfizer/phq-9/index.jsp) or http://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9/ (includes scoring guide).

Clinical Considerations

  • Can be used as a tool to screen for major depression.
  • Corresponds with the DSM-IV criteria.

Measurement Property Summary

# of studies reporting psychometric properties: 5

Reliability:

  • Internal consistency for the overall PHQ-9 scale was reported to be High (Cronbach’s a=0.83-0.89)

[Bombardier et al. 2004, Richardson and Richardson 2008, Graves & Bombardier 2008, Krause et al. 2009]

Validity:

  • Correlation of the PHQ-9 is:
    • High with the Older Adult Health and Mood Questionnaire (Spearman’s r=0.781)
    • Moderate with major depressive disorder (MDD) (Spearman’s r=0.530)
    • Moderate with the Satisfaction with Life Scale (Spearman’s r=-0.477).
  • PHQ-9 scores were inversely and Moderately correlated with subjective health on the SF-1 (Spearman’s r=0.37).
  • For a 3-item screening test with a score cutoff of 3, a sensitivity of 0.87 and specificity of 0.93 were reported; with a score cutoff of 4, a sensitivity of 0.82 and a specificity of 0.95 were reported.
  • For the total PHQ-9, a cutoff of 11 was determined to have optimal diagnostic accuracy of MDD. At this cutoff, the PHQ-9 detected 100% (sensitivity) of those with a diagnosis of MDD and had a specificity of 84%.

[Bombardier et al. 2004, Bombardier et al. 2012, Richardson and Richardson 2008, Krause et al. 2009]

Responsiveness:

No values were reported for the responsiveness of the PHQ-9 for the SCI population.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the PHQ-9 for the SCI population.

Reviewer

Dr. Vanessa Noonan, Kyle Diab

Date Last Updated:

Mar 16, 2017

Download the measure

Download Worksheet:
Measure available online in PDF format Copyright © Pfizer Inc. after agreeing to several conditions including use for research, in clinical programs or physician education. http://www.integration.samhsa.gov/images/res/PHQ%20-%20Questions.pdf (includes scoring guide).

Video

n/a

Scoring

n/a

Equipment Needed

PHQ-9:

Bombardier CH, Richards JS, Krause J, Tulsky D, Tate D. Symptoms of Major Depression in People With Spinal Cord Injury: Implications for Screening. Arch Phys Med Rehabil 2004;85:1749-1756.
http://www.ncbi.nlm.nih.gov/pubmed/15520969

Bombardier CH, Kalpakjian CV,  Graves DE, Dyer JR, Tate DG, Fann JR. Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil, 2012; 93(10):1838-1845.
http://www.ncbi.nlm.nih.gov/pubmed/22555007

Graves DE and Bombardier CH. Improving the efficiency of screening for major depression in people with spinal cord injury. J Spinal Cord Med. 2008; 31(2): 177-84.
http://www.ncbi.nlm.nih.gov/pubmed/18581665

Krause JS, Saunders LL, Reed KS, Coker J, Zhai Y, Johnson E. Comparison of the Patient Health Questionnaire and the Older Adult Health and Mood Questionnaire for self-reported depressive symptoms after spinal cord injury. Rehabilitation Psychology, 2009; 54(4): 440-448.
http://www.ncbi.nlm.nih.gov/pubmed/19929126

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.
http://www.ncbi.nlm.nih.gov/pubmed/11556941

Richardson EJ and Richards JS. Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury. Rehabilitation Psychology, 2008; 53(2):243-249.
http://psycnet.apa.org/journals/rep/53/2/243/

Williams RT, Heinemann AW, Bode RK, Wilson CS, Fann JR, Tate DG. Improving measurement properties of the Patient Health Questionnaire-9 with Rating Scale analyses. Rehabilitation Psychology 2009; 54(2): 198-203.
http://www.ncbi.nlm.nih.gov/pubmed/19469610