Outcome measure reference · for clinicians
PHQ-9 scoring, cut-offs and interpretation
PHQ-9 — Patient Health Questionnaire-9. Severity of depressive symptoms over the last two weeks.
- Items
- 9
- Each item
- 0–3
- Score range
- 0–27
- NHS TT caseness
- 10+
What it measures
The PHQ-9 is a nine-item self-report outcome measure of depressive symptom severity. Each item corresponds to one of the nine criteria for a depressive episode, rated for how often it has been a problem over the last two weeks.
In UK practice it is most familiar as one of the two core measures in NHS Talking Therapies, where it is given at assessment and at every session so change can be tracked across treatment. A total score describes severity; it is not a diagnosis, and a clinical interview remains the basis of any formulation or treatment decision.
Scoring
Sum the nine item scores (each 0–3) for a total between 0 and 27.
Formulate does not reproduce the PHQ-9 items on this page and offers no public score calculator. Use the official copy (see licence below).
Severity bands
Scores, severity bands, and outcome classifications are computed by applying published clinical thresholds. They are informational aids, not diagnoses or clinical recommendations. Clinical interpretation remains the sole responsibility of the treating practitioner.
| Score | Depression severity |
|---|---|
| 0–4 | None–minimal |
| 5–9 | Mild |
| 10–14 | Moderate |
| 15–19 | Moderately severe |
| 20–27 | Severe |
Source: Kroenke, Spitzer & Williams (2001).
NHS Talking Therapies use
- Caseness: 10 or more
- Reliable change: a change of 6 or more points
A score of 10 or more is caseness. A change of 6 or more points between two scores counts as reliable change.
Source: NHS Talking Therapies manual, v7.1 (2024).
Risk
Item 9 asks about thoughts of self-harm or of being better off dead. Any positive response to item 9 needs a risk assessment, independent of the total score — a low total does not rule out risk.
Licence and the official copy
The official PHQ Screeners site states that no permission is required to reproduce, translate, display or distribute the PHQ and GAD-7 screeners.
phqscreeners.com (opens in a new tab)
This page describes the measure and cites its published scoring. It is not endorsed by the measure’s authors, its rights holder or the NHS.
How Formulate uses the PHQ-9
- Assign it as homework: your client completes it on their own device through a secure link, without needing an account.
- Scored automatically when your client submits, and recorded against their outcomes.
- Reliable change and recovery tracked against the NHS Talking Therapies thresholds on the client’s outcomes dashboard.
- Outcome tracking is included on the Practice and Specialist plans; every account starts with a 14-day Practice trial.
References
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
- NHS England (2024). NHS Talking Therapies for anxiety and depression manual, version 7.1.
Frequently asked questions
What are the PHQ-9 cut-offs?
Kroenke, Spitzer and Williams (2001) describe totals of 5, 10, 15 and 20 as the thresholds for mild, moderate, moderately severe and severe depressive symptoms. NHS Talking Therapies treats a score of 10 or more as caseness.
What counts as reliable change on the PHQ-9?
The NHS Talking Therapies manual (v7.1, 2024) treats a change of 6 or more points between two PHQ-9 scores as reliable change.
Why does item 9 need attention on its own?
Item 9 asks about thoughts of self-harm or of being better off dead. Any positive response needs a risk assessment, whatever the total score.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
Track the PHQ-9 across your caseload
Assign it as homework, let Formulate score it, and see change over treatment alongside the rest of your client’s work.