PHQ-9 is the go-to depression screening tool used in primary care

Which screening tool is commonly used to assess for depression?

• A. The Patient Health Questionnaire-9 (PHQ-9)
• B. The General Anxiety Disorder 7-item scale (GAD-7)
• C. The Beck Depression Inventory (BDI)
• D. The Hamilton Anxiety Rating Scale (HAM-A)

Answer: (A)

The Patient Health Questionnaire-9 (PHQ-9) is widely recognized as a screening tool specifically designed to assess the presence and severity of depression. This instrument consists of nine questions that relate directly to the diagnostic criteria for major depressive disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The PHQ-9 is particularly effective because it provides both a quick screening method and a way to monitor changes in depressive symptoms over time. It is well-validated across different populations and settings, making it a preferred choice among healthcare professionals for evaluating depression. While other options such as the Beck Depression Inventory (BDI) also measure depression, the PHQ-9 is more commonly utilized in clinical practice due to its brevity and ease of use in primary care settings. The GAD-7 and the Hamilton Anxiety Rating Scale focus on anxiety, thus not serving the purpose of specifically assessing for depression.

Outline (sketch for structure)

• Opening hook: Depression screening matters in everyday care, not just tests.

• What the PHQ-9 is: a nine-item questionnaire tied to DSM criteria, quick to complete, easy to score.

• Why it’s the common go-to: brevity, validity, good tracking over time, works well in primary care and beyond.

• Quick compare: how PHQ-9 stacks up against BDI, GAD-7, and HAM-A.

• How the scoring works: a simple 0–27 scale with clear cutoffs, plus what those numbers mean for care.

• Using PHQ-9 in real life: administration, interpretation, safety checks for suicidal thoughts, follow-up steps.

• Limitations and nuance: screening isn’t a diagnosis, watch for cultural and somatic factors, co-occurring conditions.

• Practical tips: talking with patients, integrating into workflows, and monitoring change over weeks.

• Takeaway: PHQ-9 as a reliable, patient-friendly tool that supports clinical judgment.

Which screening tool best flags depression? PHQ-9 is the one most people reach for

Let me ask you this: in a busy clinic, what’s the tool that can tell you, in just a few minutes, whether someone is wrestling with depression and how that mood might be shifting over time? The answer most clinicians land on is the PHQ-9—the Patient Health Questionnaire-9. It’s designed specifically to screen for major depressive disorder and to track how symptoms change. In plain terms, it’s a quick, reliable way to see if someone is struggling with mood, sleep, energy, or focus, and whether those struggles are likely to require more support.

What the PHQ-9 actually is

The PHQ-9 is nine questions, each tied to the diagnostic criteria for major depressive disorder in the DSM. The questions focus on everyday experiences—things like losing interest in activities you once enjoyed, feeling down or hopeless, trouble sleeping, fatigue, changes in appetite, and concentration issues. Two things matter here: first, it’s directly linked to diagnostic criteria, which helps clinicians align symptoms with established medical thinking. Second, it’s short. Most people can complete it in a few minutes, and clinicians can score it in seconds.

Why it’s so widely used

There are a few reasons PHQ-9 has become the default tool in many settings:

• Brevity and clarity: Nine items, simple scoring. It’s easy to administer without pulling people into a long survey.

• Valid across diverse groups: Across ages, cultures, and health conditions, the PHQ-9 generally performs well, which helps teams feel confident using it with a broad patient mix.

• Tracks change over time: Because you’re scoring the same questions repeatedly, it’s great for watching whether symptoms are improving, staying the same, or getting worse.

• The practical fit for primary care: Primary care teams are often juggling lots of concerns in a short visit. A quick, reliable screen fits neatly into routines, notes, and electronic health records.

A quick side-by-side with similar tools

• BDI (Beck Depression Inventory): It’s solid and thorough, but it’s longer. For a fast screen in a busy setting, the PHQ-9 usually wins on practicality.

• GAD-7 (General Anxiety Disorder 7-item scale): This one focuses on anxiety, not depression. Some patients have both mood and anxiety symptoms, so clinicians might use GAD-7 alongside PHQ-9, but for depression alone, PHQ-9 is the standard.

• HAM-A (Hamilton Anxiety Rating Scale): Also targeted at anxiety. It’s more common in specialty mental health settings and requires clinician administration. For depression screening, PHQ-9 remains the go-to.

How the scoring works (and why those numbers matter)

Each item on the PHQ-9 is scored from 0 to 3, with 0 meaning “not at all” and 3 meaning “nearly every day.” Add the nine items up and you get a total score from 0 to 27. Here’s a practical read on what the scores tend to map to:

• 0–4: minimal symptoms

• 5–9: mild depression

• 10–14: moderate depression

• 15–19: moderately severe depression

• 20–27: severe depression

These cutoffs are not a diagnosis on their own. They’re flags that tell you: this person could benefit from a closer look, a collaborative plan, and possibly treatment. The real value is in watching where someone lands on the scale at different visits, so you can see if things are shifting over time.

Using PHQ-9 in real life

Here’s a practical picture of how it shows up in care:

• Administering: The patient can fill it out themselves in the waiting room or you can go through it at the bedside. It’s common to pair it with a quick, casual chat about mood and sleep to set the stage.

• Interpreting: Look at both the total score and the individual item responses. Sometimes someone might report many somatic symptoms (sleep disruption, fatigue, appetite changes) without overwhelming mood complaints. That still matters and should be explored.

• Safety check: If any item indicates thoughts of being better off dead or harming self, you pause the screen to do a safety assessment. This part is non-negotiable; it’s about immediate care and support.

• Follow-up actions: A higher score often leads to a stepped plan—referral to psychotherapy, consideration of pharmacotherapy, or both. Even smaller increases can prompt a brief check-in, a resource handout, or a structured self-management plan.

A natural, patient-friendly way to talk about it

clinicians often find that framing matters. You might say, “This short form helps us track how you’re feeling over time. It’s not a test you pass or fail; it’s a tool to guide our next steps.” That kind, factual language reduces defensiveness and makes the process feel collaborative. A patient who understands the purpose tends to be more open and engaged in the plan, which in turn improves the accuracy of subsequent screenings.

Limitations and the bigger picture

No tool is perfect, and PHQ-9 is no exception. Some caveats to keep in mind:

• Screening vs. diagnosis: A high PHQ-9 score doesn’t prove depression. It signals the need for a fuller assessment, including history, functional impact, and medical factors.

• Co-occurring conditions: Anxiety, substance use, chronic illness, or pain can muddy the picture. You may see overlapping symptoms that call for a broader evaluation.

• Cultural and language nuances: Some expressions of distress don’t map cleanly onto the PHQ-9 items in every culture or language. When language barriers exist, use validated translations and consider a culturally adapted approach.

• Somatic symptom bias: People with high physical symptom burden might rate mood symptoms differently. The score should be interpreted within the whole clinical context.

Practical tips for teams and learners

• Integrate smoothly: Put PHQ-9 into the flow of intake or annual check-ins. A brief 3–5 minute screen can be a powerful early signal.

• Use it as a conversation starter: If a patient’s score is high, invite them to elaborate on what those symptoms feel like in daily life. A simple follow-up like, “What’s been hardest for you lately?” can open doors.

• Pair with action steps: For moderate-to-severe scores, outline next steps up front—psychotherapy referrals, medication considerations, sleep hygiene, activity planning, or social support resources.

• Track over time: Keep a simple chart in the chart note or patient portal. A few ticks up or down tell you more than a single number ever could.

• Stay grounded in safety: Always have a plan for distress or suicidal ideation. If you’re unsure how to conduct a safety assessment, a quick consult with a mental health colleague can be a lifesaver.

A note on workflow and literacy

In busy real-world settings, PHQ-9 shines when paired with thoughtful workflow:

• Digital versions can populate directly into the chart, saving time and reducing math errors.

• Brief clinician prompts tied to score bands can help with consistency in follow-up.

• Clear, plain-language explanations of what the score means help patients feel seen, not judged.

Why this matters for mental health work

Screening is a compass, not a map. The PHQ-9 points you toward patients who may need more help, but it doesn’t replace a thorough clinical interview, a review of medical history, or a discussion of social determinants of health. It works best as part of a holistic approach: ask about sleep, energy, relationships, work, and safety; consider medications and medical conditions; validate experiences; and collaborate on a plan that fits the person’s goals.

A final thought

If you’re staring down a patient with mood symptoms, the PHQ-9 is often your most efficient ally. It’s concise, anchored in well-established criteria, and easy to track across time. In the right hands, a simple nine-item questionnaire becomes a meaningful map—one that helps patients move toward relief, resilience, and a sense of forward momentum.

If you’d like, I can tailor a quick, practical guide for your setting—whether you’re in primary care, a community clinic, or a behavioral health team—so you can implement PHQ-9 smoothly and confidently. After all, a thoughtful screen is the first step toward thoughtful care, and that makes all the difference.