PHQ-9 Depression Screening: PHQ-9 scoring and how to interpret it safely
- Kiesa Kelly
- 4 days ago
- 7 min read
Last reviewed: 02/19/2026
Reviewed by: Dr. Kiesa Kelly
If you’ve taken an online depression screening and you’re staring at a number, you’re not alone. Understanding PHQ-9 score meaning can help you make safer, calmer decisions about what to do next, without turning a questionnaire into a label.
In this article, you’ll learn:
What the PHQ-9 measures (and what it doesn’t)
How scoring works, including why one item can matter
PHQ-9 severity ranges and how to interpret them with context
How to read results without self-blame
When to get urgent support and what to do next
🧭 Key takeaway: The PHQ-9 is a helpful starting point for a conversation about depression symptoms, not a final diagnosis. [1]
What the PHQ-9 Measures (and Why It’s Used)
The PHQ-9 (Patient Health Questionnaire-9) is a brief, widely used depression screening tool. It asks about core depression symptoms and how often you’ve experienced them recently, then totals the answers into a score from 0 to 27. It’s widely used because it’s brief. [1]
Symptoms over the last two weeks
The PHQ-9 asks about the last two weeks. A rough stretch (illness, finals, conflict, grief, major sleep loss) can raise your score.
The nine items cover areas like low mood, loss of interest, sleep and appetite changes, fatigue, concentration, feeling slowed down or restless, and thoughts that you’d be better off dead or of hurting yourself. [3]
Screening vs diagnosis (what it can/can’t do)
A PHQ-9 result can suggest “this deserves a closer look,” but it can’t diagnose depression by itself. Diagnosis requires a clinical evaluation, including:
How long symptoms have been present and whether they come and go
Whether something else could explain them (medical issues, substances, grief, bipolar-spectrum symptoms)
How much they’re affecting daily function and safety
Many guidelines emphasize that screening works best when there’s a clear plan for follow-up and appropriate care. [5]
PHQ-9 Scoring Basics
How the total score is calculated
Each item is rated by frequency:
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3) [3]
Add the nine item scores to get a total from 0 to 27. [1]
🧮 Key takeaway: Because the total is a simple sum, small shifts in sleep, stress, or health can change the number. [3]
Why one item can matter even if the total is low
Two parts of the PHQ-9 deserve special attention beyond the total score.
First, the functional question asks how difficult these problems have made it to work, take care of home responsibilities, or get along with others. In practice, impairment often guides urgency more than the number alone. [6]
Second, item 9 (self-harm/suicidal thoughts) should be taken seriously even when the total is low. It needs follow-up with someone qualified to assess risk and support safety. [4]
Practical example #1:
You score a 4 overall (minimal range), but you endorsed item 9 as “several days.” The safest next step is to talk with a professional or crisis support now, rather than trying to “logic” your way out of it because the total looks low. [4]
PHQ-9 Score Meaning: Severity Ranges and What They Usually Mean
PHQ-9 severity ranges are commonly grouped like this:
0–4: none/minimal
5–9: mild
10–14: moderate
15–19: moderately severe
20–27: severe [2]
These cutpoints help clinicians and clients share a common language, but they’re not a verdict on you or a precise measure of “how depressed you really are.” [1]
Ranges as a conversation starter, not a verdict
Misconception #1: “My score proves I have depression.”
A score can suggest depression is more or less likely, but diagnosis still requires context and evaluation. [5]
Misconception #2: “A high score means I’m broken or I’ll never get better.”
A higher score means symptoms have been frequent lately. It does not predict your future or your worth.
The importance of impairment (work, parenting, relationships)
Two people can have the same total score and very different impairment.
Practical example #2:
Two adults both score a 9 (mild range). One is tired and less motivated but still working, parenting, and connecting with friends. The other is missing work, withdrawing from family, and can’t keep up with basic responsibilities. Same number, different urgency and support needs.
That’s why clinicians consider both the score and the impairment question. PHQ-9 scores are strongly associated with functional difficulty and disability days. [1][6]
📌 Key takeaway: Severity ranges are most useful when you pair them with impairment and safety, not when you use them to judge yourself. [1]
How to Read Your Results Without Self-Blame
Depression is not a willpower issue
Misconception #3: “If I just tried harder, I wouldn’t feel this way.”
Depression symptoms are influenced by brain and body systems, life stress, and environment. Many people are working incredibly hard while feeling depleted. The goal is support and skills, not shame.
💛 Key takeaway: Treat your score as information about what you’ve been carrying, not evidence that you’re failing. [5]
What changes scores: sleep, stress, burnout, health issues
It can help to ask, “What changed in the last two weeks?” Common drivers include sleep disruption, burnout, illness or pain, medication changes, and heavier alcohol or cannabis use.
If you’re tracking over time, look for trends across several check-ins rather than one isolated score.
A Special Note About Safety
If you endorsed self-harm/suicidal thoughts, get support now
If you marked anything other than “not at all” on item 9, it’s important to get support today. Endorsing item 9 is associated with increased risk for later suicidal behavior, which is why it should prompt follow-up and a more complete risk assessment. [7]
At the same time, item 9 is not a full suicide-risk assessment on its own. It can miss risk in some people and over-flag in others, so don’t use it as a solo “pass/fail” test. [8]
🚨 Key takeaway: Any self-harm or “better off dead” thoughts deserve real-time support, even if you’re unsure what you want. [4][9]
What “urgent support” looks like (crisis lines, ER, trusted person)
If you feel unsafe, can’t stop thinking about suicide, or might act on thoughts, treat it as urgent.
Options in the U.S. include:
Call or text 988 to reach the 988 Suicide & Crisis Lifeline (24/7), or use chat online. [9]
If you’re in Tennessee, you can also find state-specific information about 988 through the Tennessee Department of Mental Health and Substance Abuse Services. [10]
If you are in immediate danger, call 911 or go to the nearest emergency room.
If you can, tell one trusted person what’s happening and ask them to stay with you while you connect to help.
What to Do Next Based on Your Results
These are common “next step” patterns clinicians use to match support to severity and function.
Mild symptoms: monitoring + supports
If you’re in the mild range and functioning is mostly intact, consider:
Re-taking the PHQ-9 in 2–4 weeks to track change
Prioritizing sleep and basic routines
One or two small “load reducers” (a delegated task, a boundary)
Therapy focused on coping skills
Moderate+ symptoms: talk with a professional
Moderate, moderately severe, and severe ranges are good reasons to talk with a professional, especially if symptoms have lasted more than two weeks or are affecting work, school, parenting, or relationships. [2][5]
A clinician may explore duration, safety, anxiety or trauma, medical contributors, and what support would help you function better.
If symptoms are persistent: evaluation and treatment options (high level)
Common evidence-based options include psychotherapy (such as CBT or ACT), medication (through a medical prescriber), or a combination. What fits best depends on your history, preferences, severity, and safety needs. [5]
✅ Key takeaway: The most helpful question is usually “What level of support matches what I’m dealing with right now?” not “What’s wrong with me?”
Take the PHQ-9 + Next Steps
Access the PHQ-9
If you want to take (or retake) the tool, you can use our PHQ-9 depression screener. Remember: the goal is clarity and safety, not a perfect score.
Explore additional screeners
For other validated screeners and guidance, visit our mental health screening hub.
If you’re looking for depression help in Tennessee, ScienceWorks Behavioral Healthcare offers telehealth therapy for Tennessee residents, which can make support easier to access when motivation and energy are low. You can learn about our specialized therapy options, explore psychological assessments when you want diagnostic clarity, and contact ScienceWorks when you’re ready to talk.
A quick summary:
Use the PHQ-9 as a depression screening tool, not a diagnosis.
Interpret the number alongside impairment and context.
Treat item 9 as a safety signal that deserves immediate follow-up.
If symptoms are sticking around, you don’t have to manage them alone.
About the Author
Dr. Kiesa Kelly is a licensed clinical psychologist and neuropsychologist by training at ScienceWorks Behavioral Healthcare. She has 20+ years of experience with psychological assessment and provides evidence-based care for OCD, trauma, insomnia, and neurodivergence-affirming assessment and treatment planning.
She provides services via telehealth in many states, including Tennessee, and focuses on helping clients find a clear, self-affirming path forward. Learn more about Dr. Kiesa Kelly.
References
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x. Available from: https://doi.org/10.1046/j.1525-1497.2001.016009606.x
American Psychiatric Association. Severity Measure for Depression—Adult (PHQ-9). DSM-5. Available from: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Severity-Measure-For-Depression-Adult.pdf
American Psychological Association. Patient Health Questionnaire (PHQ-9). Available from: https://www.apa.org/depression-guideline/patient-health-questionnaire.pdf
University of Washington. Patient Health Questionnaire-9 (PHQ-9) (screening and interpretation). Available from: https://www.hiv.uw.edu/page/mental-health-screening/phq-9
US Preventive Services Task Force. Depression and Suicide Risk in Adults: Screening. Recommendation statement (Jun 20, 2023). Available from: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-adults
Government of British Columbia. Patient Health Questionnaire (PHQ-9). Depression guideline appendix (PDF). Available from: https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/depression_patient_health_questionnaire.pdf
Rossom RC, Coleman KJ, Ahmedani BK, et al. Suicidal ideation reported on the PHQ-9 and risk of suicidal behavior across age groups. J Affect Disord. 2017. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5412508/
Na PJ, Yaramala SR, Kim JA, et al. The PHQ-9 item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)-9 item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). J Affect Disord. 2018. Available from: https://pubmed.ncbi.nlm.nih.gov/29477096/
Substance Abuse and Mental Health Services Administration (SAMHSA). 988 Frequently Asked Questions. Updated Dec 16, 2025. Available from: https://www.samhsa.gov/mental-health/988/faqs
Tennessee Department of Mental Health and Substance Abuse Services. 988 Suicide & Crisis Lifeline. Available from: https://www.tn.gov/behavioral-health/crisis/988.html
Disclaimer
This article is for informational purposes only and is not a substitute for professional diagnosis, treatment, or medical advice. If you are in immediate danger, call 911 or go to the nearest emergency room.