PHQ-9 score meaning: what each band says and what to do next

A PHQ-9 score is a number from 0 to 27 that shows how often nine common signs of low mood have bothered you over the last two weeks. A score of 0 to 4 shows few signs, 5 to 9 is mild, 10 to 14 is moderate, 15 to 19 is high and 20 to 27 is very high. It isn’t a diagnosis, but from 10 upwards it’s a good reason to talk to a doctor, and any answer other than “not at all” on the last question, about hurting yourself, is worth raising with a doctor whatever your total.

How is the PHQ-9 scored?

Each of the nine questions asks how often something has bothered you over the last two weeks, and each answer has a score: “not at all” is 0, “several days” is 1, “more than half the days” is 2 and “nearly every day” is 3. The nine scores are added up, so the lowest possible total is 0 and the highest is 27.

The questions cover the main signs doctors look for when they assess depression:

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’re a failure or have let yourself or your family down
7. Trouble concentrating, for example on reading or watching television
8. Moving or speaking slowly enough for others to notice, or being much more fidgety or restless than usual
9. Thoughts that you would be better off dead, or of hurting yourself in some way

The questionnaire was developed by doctors Kurt Kroenke, Robert Spitzer and Janet Williams, who published it in 2001, and it’s now one of the most widely used short questionnaires about low mood in the world. GPs often use it in appointments, and it’s also used to follow how someone is doing during treatment.

The original paper form ends with one more question: how difficult these problems have made it to work, take care of things at home or get along with other people. That question isn’t part of the score, and our PHQ-9 depression test leaves it out, but it’s worth asking yourself. Two people with the same total can be coping very differently.

What do the PHQ-9 score ranges mean?

Higher scores mean the signs of low mood have been bothering you more often. The bands below are the ones Sprout uses. The paper that introduced the PHQ-9 gave them more clinical names, which you may see elsewhere, so both are shown.

0 to 4: few signs

Your answers suggest low mood hasn’t been taking over in the last two weeks. Everyone has flat or tired days, and a score here doesn’t mean you never feel low. It means those days aren’t piling up. It can still help to notice what keeps you steady, such as sleep, time outdoors or people you enjoy, so you can lean on it when things get harder.

5 to 9: mild

You’ve had some days when your mood, energy or interest in things dipped. This is very common, especially during busy or stressful stretches, and it often lifts on its own. Gentle routines, movement, daylight and talking with people you trust all help. Retaking the questionnaire in a couple of weeks is a good way to see whether it’s easing or settling in.

Look at which questions scored. A 6 made up mostly of sleep, energy and appetite reads differently from a 6 made up of feeling hopeless and bad about yourself. The first can come from poor sleep, stress or a physical cause; the second is closer to the heart of low mood.

10 to 14: moderate

Low mood has been showing up often, and it’s probably been affecting your days. You may have felt down, tired or less interested in things you usually care about. This is the point where talking to a doctor is a sensible next step. That doesn’t mean something drastic will happen: often the first conversation is about what’s been going on, what might be behind it and what options there are.

15 to 19: high

Low mood seems to have been with you much of the time, and it’s likely making everyday life feel harder. Things that used to be easy may take a lot of effort. Please consider speaking to a doctor soon rather than waiting to see if it passes. Feelings like these are common and there is real help available.

20 to 27: very high

Low mood seems to have been very heavy and present nearly all the time. You may feel worn out, hopeless or cut off from things that normally matter to you. Please reach out to a doctor soon. If you ever feel unsafe, contact your local emergency number straight away.

Why does question 9 matter whatever your total?

The last question asks how often you’ve had thoughts that you would be better off dead, or of hurting yourself in some way. Any answer above “not at all” on that question is worth talking to a doctor about, even if the rest of your answers add up to a low score. A total of 4 with “several days” on question 9 deserves more attention than a total of 12 without it.

That’s why, when you take the PHQ-9 on Sprout, any answer other than “not at all” on that question brings up support information alongside your result, whatever the total is.

Having these thoughts doesn’t mean you will act on them, and it doesn’t mean something is wrong with you as a person. They’re a sign of how much you’re carrying. Saying them out loud to a doctor can feel hard, but doctors hear this often, and it helps them understand what kind of support fits. You can simply say: “I took the PHQ-9 and I answered ‘several days’ on the question about hurting myself.”

Is a PHQ-9 score of 10 or more a diagnosis of depression?

No. A score of 10 or more means low mood has been bothering you often enough that it’s worth a proper look, but only a professional can tell whether it’s depression. In the 2001 study that introduced the questionnaire, Kroenke and colleagues found that a score of 10 or more picked up 88% of the people who had major depression, and that 88% of the people without it scored below 10. That makes it a good screening line, not a verdict.

A doctor looks at things a questionnaire can’t:

• how long you’ve felt this way, and whether it came on after something specific
• how much it’s affecting your work, home life and relationships
• whether a physical cause, a medicine or a recent loss could explain it
• your history, including any earlier spells of low mood

So a high score is not a label, and a low score is not a reason to ignore how you feel. If you’re struggling and your score doesn’t seem to match, trust how you feel and talk to someone anyway. If you’re still unsure whether this is a passing low or something more, it can help to read about sadness versus depression and how long each tends to last.

What can push your score up when it isn’t depression?

Several PHQ-9 questions ask about things that can have other causes: sleep, tiredness, appetite, concentration and restlessness. That means your total can rise for reasons that aren’t mainly about mood.

• Poor sleep. A few weeks of broken nights can push up the sleep, energy and concentration questions on their own. If tiredness is the biggest thing for you, it’s worth looking at the reasons you feel tired more broadly.
• Long-running stress or burnout. Exhaustion, poor focus and feeling like you’re failing at work overlap with low mood. The signs of burnout are similar, though burnout is usually tied more closely to one area of life.
• Physical health. Illness, pain, hormonal changes and some medicines can affect sleep, appetite and energy. A doctor can check for these.
• Anxiety. Worry often brings poor sleep, restlessness and trouble concentrating. Low mood and anxiety also often come together. If worry is a big part of how you feel, the GAD-7 anxiety test is a useful companion, and our post on GAD-7 score bands explains its results.

None of this means you should explain your score away. It means the pattern of answers matters as much as the total, and it’s useful to bring that pattern to a doctor.

What should you do after a moderate or higher score?

The most useful step is to book an appointment with your GP or doctor and tell them what you’ve noticed. You don’t need to know what’s wrong first. That’s their job.

Before the appointment

• Write down your score and which questions you answered “more than half the days” or “nearly every day”.
• Note roughly when this started, and anything that was happening around then.
• List any medicines you take and any physical symptoms, such as pain or changes in weight.
• If you answered anything above “not at all” on question 9, put it at the top of the list, so it doesn’t get lost if you feel nervous.

In the meantime

Small things won’t fix depression on their own, but they can take the edge off while you get support. Try to keep a regular time for getting up, get some daylight early in the day, move a little even if it’s just a short walk, and eat something regular. Tell one person you trust how you’ve been feeling. When the inner voice gets harsh, it can help to practise being kinder to yourself, because low mood often brings a lot of self-criticism with it.

Talk to your doctor about treatment options. For many people, talking therapies help, and a doctor can explain what’s available where you live.

How often should you retake the PHQ-9?

Every two weeks or so works well, because the questions ask about the last two weeks. Taking it more often mostly re-measures the same days.

The trend tells you more than any one result. If your score drops from 16 to 11 to 8 over six weeks, things are moving in the right direction, even if 8 still doesn’t feel great. If it climbs, or stays high for several rounds, that’s a reason to go back to your doctor and say so. Bringing a few results to an appointment gives them a clearer picture than “I’ve been feeling a bit low”.

Try to take it in similar conditions each time, and answer for the whole two weeks rather than how you feel this afternoon. One unusually good or bad day can nudge the numbers, which is another reason to look at the shape over time.

Should you take a shorter or longer check instead?

If you’re not sure where to start, the quick mood and worry check (the PHQ-4) takes about a minute. Its first two questions about low mood are the first two of the PHQ-9, so if that part comes out raised, the full PHQ-9 is the natural next step.

The PHQ-9 itself is short on purpose. It gives you and your doctor a common language for how you’ve been, not a full assessment. If you’ve read this far because a number is sitting with you, the most useful thing you can do with it is take it to someone who can help. And if you haven’t taken it yet, you can check your PHQ-9 score in about three minutes, then come back here to read what your band means.