PHQ-9 Test Online — Patient Health Questionnaire (9-Item Depression Scale)

The 9 PHQ-9 questions

The questionnaire asks how often, over the past 2 weeks, you have been bothered by each of the following:

1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a failure, or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed — or the opposite, being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead, or of hurting yourself in some way (safety item — see crisis information above)

Each item is scored on a 4-point scale: 0 = Not at all · 1 = Several days · 2 = More than half the days · 3 = Nearly every day. The nine scores are summed for a total in the range 0-27.

PHQ-9 score interpretation

| Score | Severity | What it means | Suggested next step | |---|---|---|---| | 0-4 | Minimal depression | Symptoms typical for everyday life | Continue self-monitoring | | 5-9 | Mild depression | Some symptoms but mostly functioning | Lifestyle, therapy if persistent; retake in 2-4 weeks | | 10-14 | Moderate depression | Symptoms causing impairment | Clinical evaluation; therapy with or without medication | | 15-19 | Moderately severe | Significant symptoms and clear impairment | Clinical evaluation; combination therapy + medication often indicated | | 20-27 | Severe depression | Major symptoms, often impairing core function | Urgent clinical evaluation; intensive treatment usually required |

Special rule: any response other than "Not at all" on Question 9 (self-harm) requires same-day clinical contact regardless of total score. A score of 8 with a positive Question 9 is more clinically urgent than a score of 18 without it.

How the PHQ-9 was developed

The PHQ-9 was developed by Robert L. Spitzer, Kurt Kroenke, and Janet B. W. Williams as part of the broader Patient Health Questionnaire (PHQ), refined through the PRIME-MD diagnostic interview, and published in the Journal of General Internal Medicine in 1999.

Initial validation drew on 6,000 patients across 8 primary-care and obstetrics/gynaecology clinics in the US. Subsequent studies validated the instrument across dozens of countries, age groups, medical conditions, and clinical populations. The PHQ-9 is now the recommended depression screener of the World Health Organisation and the US Preventive Services Task Force, the primary outcome measure in the STAR*D trial (the largest US depression treatment trial), and the routine first-line instrument across NIMHANS, AIIMS, and Indian private psychiatric practice.

Indian validation studies have confirmed accuracy across urban and rural populations and across the major Indian languages.

PHQ-9 vs other depression tests

| Test | Items | Time | Best for | Indian validation | |---|---|---|---|---| | PHQ-9 | 9 | 3 min | General screening, treatment monitoring | Yes | | HAM-D | 17 | 4 min | Clinician-administered detailed assessment | Yes | | MADRS | 10 | 3 min | Clinician-administered; sensitive to medication response | Research | | EPDS | 10 | 3 min | Postnatal depression | Yes | | DASS-21 | 21 | 4 min | Combined depression + anxiety + stress | Yes |

The PHQ-9 is the standard first-line test. Use HAM-D or MADRS for clinician-administered detailed assessment, EPDS if perinatal depression is the concern, and DASS-21 for a combined depression-anxiety-stress picture.

When to act on your result

• Score 0-4: No action needed. Continue self-monitoring if low mood is a recent concern.
• Score 5-9: Behavioural activation, sleep hygiene, mindfulness. The CBT Thought Record and Behavioural Activation worksheets in the adult worksheets library are evidence-based for this band. Retake the PHQ-9 in 2-4 weeks.
• Score 10-14: Clinical evaluation recommended. Book a Mindtalk psychiatrist or clinical psychologist. CBT, IPT, and Behavioural Activation are first-line therapies; medication may or may not be needed depending on history and preference.
• Score 15-19: Clinical evaluation needed. Combination therapy + medication is often indicated.
• Score 20-27: Urgent clinical evaluation. Intensive treatment is usually required.
• Question 9 positive (any "Several days" or higher): Same-day clinical contact regardless of total score. Crisis helplines are listed above.

After the PHQ-9

• Track over time. Retake every 2-4 weeks during treatment; the Mindtalk app charts response automatically.
• Start a structured programme. The 90-day Depression-Anxiety-Stress Rehabilitation journey is designed for PHQ-9 scores in the 10-19 band.
• CBT toolkit. The Thought Record and Cognitive Distortions worksheet are the workhorses; Behavioural Activation is in the adult worksheets library.
• Daily mood tracking. The Mindtalk app's daily mood log pairs well with PHQ-9 monitoring — patterns emerge faster than from PHQ-9 scores alone.
• Book a specialist. Mindtalk's psychiatrists and clinical psychologists treat depression across Bangalore, Hyderabad, Mysore, and online for anywhere in India.