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Patient Health Questionnaire (PHQ-9)
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About Patient Health Questionnaire (PHQ-9)
Scale Name
Patient Health Questionnaire (PHQ-9)
Author Details
Dr. Robert L. Spitzer, Dr. Janet B. W. Williams and Dr. Kurt Kroenke
Translation Availability
Not Sure
Background/Description
Emerging from the late 1990s, the Patient Health Questionnaire-9 (PHQ-9) stands as a testament to collaboration in mental health. Led by a triumvirate of experts – Dr. Robert L. Spitzer, a psychiatrist and DSM architect, Dr. Janet B. W. Williams, a psychologist versed in assessment tools, and Dr. Kurt Kroenke, a primary care physician focused on integrating mental health services – the PHQ-9 was born.
Prior to its inception, the PRIME-MD served as a broader mental health screening tool. Recognizing the need for a focused and user-friendly instrument specifically for depression, the PHQ-9 emerged as a streamlined version, retaining the core strengths of its predecessor while offering increased accessibility. This was further facilitated by funding from Pfizer, Inc., allowing for wider dissemination and research.
The PHQ-9’s concise structure revolves around nine key questions, probing the frequency of depression symptoms experienced within the previous two weeks. Each question is scored on a simple 0-3 scale, translating to “not at all” to “nearly every day”. This easy-to-grasp system facilitates both self-reporting by patients and scoring by healthcare professionals.
Administration, Scoring and Interpretation
For Patients:
- Setting the Stage: Find a quiet and comfortable place where you can focus on the questionnaire without distractions. Make sure you have a pen or pencil and the PHQ-9 form or digital version readily available.
- Reading the Introduction: Carefully read the introductory section on the PHQ-9 form. It usually explains the purpose of the questionnaire, how to answer the questions, and how to score your results.
- Answering the Questions: Take your time to answer each of the nine questions honestly and thoughtfully. Consider how often you experienced each symptom over the past two weeks, using the provided 0-3 scale (0 = not at all, 3 = nearly every day).
- Scoring Your Results: Once you’ve answered all questions, follow the instructions for scoring provided on the form or through the digital platform. Typically, you simply add up the scores for each question to get your total score.
- Interpreting Your Results: The total score on the PHQ-9 can range from 0 to 27, with higher scores indicating greater severity of depression symptoms. Refer to the scoring guide provided alongside the questionnaire to understand what your score might signify.
- Seeking Help: Regardless of your score, consider discussing your results with a healthcare professional. They can provide further evaluation, diagnosis, and appropriate treatment if needed.
For Healthcare Professionals:
- Understanding the Purpose: Explain the purpose of the PHQ-9 to your patient and how it can help assess their mental health.
- Providing Instructions: Clearly explain the instructions for completing the questionnaire, emphasizing the importance of honest and accurate responses.
- Facilitating Completion: If needed, assist your patient in understanding the questions and scoring their results.
- Interpreting Scores: Consider the patient’s score in conjunction with other clinical information and observations to form a comprehensive assessment.
- Taking Action: Based on your evaluation, discuss appropriate next steps with your patient, which may include further assessment, treatment options, or referrals.
Reliability and Validity
The Patient Health Questionnaire-9 (PHQ-9) has been extensively studied and possesses strong evidence for both reliability and validity, making it a widely used and trusted tool for assessing depression severity.
- Internal consistency: High Cronbach’s alpha coefficients (typically above 0.8) across various populations and studies indicate strong internal consistency, meaning the items on the questionnaire consistently measure the same underlying construct (depression).
- Test-retest reliability: Moderate to high correlations between scores obtained on separate test occasions suggest the PHQ-9 provides relatively stable results over time.
- Convergent validity: High correlations with other established measures of depression, such as the Hamilton Rating Scale for Depression (HRS-D), support the PHQ-9’s ability to accurately reflect depression symptoms.
- Discriminant validity: Moderate correlations with measures of anxiety and other mental health conditions indicate the PHQ-9 can differentiate depression from other disorders.
- Criterion validity: Strong sensitivity and specificity in identifying clinical depression cases compared to diagnostic interviews add to the PHQ-9’s validity.
Available Versions
09-Items
Reference
Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. General hospital psychiatry, 32(4), 345-359.
Important Link
Scale File:
Frequently Asked Questions
What is it?
Short (9-question) self-report tool for assessing depression severity.
Who uses it?
Patients, healthcare professionals, researchers.
What does it measure?
Frequency of depression symptoms in the past 2 weeks.
How is it scored?
0-3 points per question, total score from 0-27.
What do the scores mean?
Higher scores indicate more severe depression symptoms.
Is it a diagnosis tool?
No, it’s a screening tool. Consult a healthcare professional for diagnosis.
Is it reliable and valid?
Yes, strong evidence for both.
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