PHQ-9 Scoring and Interpretation: A Practical Guide for Clinicians

The PHQ-9 is the workhorse of depression measurement: nine items, scored 0-3 over the last two weeks, total 0-27, free to use, and sensitive to change. Here's the practical scoring knowledge, in one place.

Severity bands

• 0-4 Minimal — intervention typically not indicated
• 5-9 Mild — monitor, psychoeducation, repeat administration
• 10-14 Moderate — the common treatment threshold
• 15-19 Moderately severe — active treatment indicated
• 20-27 Severe — active treatment, assess comorbidity and safety

The widely used clinical cut-off is 10 or more, which balances sensitivity and specificity for major depressive disorder in validation studies.

Item 9 is not just another item

Any non-zero response to item 9 ("thoughts that you would be better off dead or of hurting yourself") warrants direct risk assessment in conversation, regardless of the total score. A total of 6 with item 9 endorsed matters more than a 12 without it. Good software should flag this automatically — PsychApp does.

Using change scores properly

A change of about 5 points is commonly treated as clinically meaningful; movement across a severity band strengthens the signal. Administer at intake and every 2 to 4 sessions. If there's no reliable improvement by session 4 to 6, that's a formulation-and-plan conversation, not a failure.

Practical administration tips

• Send it before session so results are ready to discuss, not eating session time.
• Chart the trend and show it to the client — visible progress is itself therapeutic.
• Pair with the GAD-7 when anxiety co-presents; the PHQ-4 works as an ultra-brief combined screen between full administrations.

In PsychApp, the PHQ-9 (and 23 other instruments) is assigned in two clicks, completed by the client through a secure link, auto-scored with these exact bands, summarized, and trended across administrations. See the assessment library.