PHQ-9 Depression Test: What Your Score Means and What to Do Next

The PHQ-9 (Patient Health Questionnaire-9) is the most widely used depression screening tool in primary care worldwide. It takes about 2 minutes, is free, and gives you an objective measure of how severe depression symptoms have been over the past 2 weeks. The CANMAT (Canadian Network for Mood and Anxiety Treatments) guidelines, the US Preventive Services Task Force, and the American Academy of Family Physicians all recommend it as a first-step depression screen. Here's how to take it, what your score means, and what to do next.

If You're in Crisis

If you're having thoughts of self-harm or suicide, call or text 9-8-8 (Canada Suicide Crisis Helpline), available 24/7, free, and confidential. Skip the test if you need help right now.

The 9 Questions

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Not at all = 0 · Several days = 1 · More than half the days = 2 · Nearly every day = 3

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself — or that you are a failure or have let yourself or your family down

Trouble concentrating on things, such as reading the newspaper or watching television

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

Thoughts that you would be better off dead, or of hurting yourself in some way

Important note about question 9

Any non-zero answer on question 9 (thoughts of being better off dead or self-harm) warrants a conversation with a doctor or mental-health professional regardless of your total score — even a 1 (“several days”). If these thoughts are urgent or you're thinking of acting on them, call or text 9-8-8 right now.

What Your Score Means

0-4

No or minimal depression

You are likely not experiencing clinically significant depression. If symptoms appear later, retake the test.

What to do: No medical action needed. Maintain healthy routines (sleep, exercise, social connection). Re-screen if symptoms emerge.

5-9

Mild depression

You have some depressive symptoms. Many people in this range improve with self-care strategies, lifestyle changes, or psychotherapy alone.

What to do: Consider self-help: structured exercise, sleep hygiene, social support, brief psychotherapy or self-guided CBT. Talk to a doctor if symptoms persist 4+ weeks despite self-care, if function is impacted, or if you have any thoughts of self-harm.

10-14

Moderate depression (clinically significant)

Standard cutoff for clinically significant depression. At score 10+, the PHQ-9 has 88% sensitivity and 85% specificity for major depressive disorder. Self-care alone is unlikely to be sufficient.

What to do: Book a medical evaluation within the next 1-2 weeks. Treatment options include cognitive behavioural therapy (CBT), interpersonal therapy (IPT), antidepressant medication (SSRIs are first-line per CANMAT), or combination treatment.

15-19

Moderately severe depression

Significant symptom burden likely interfering with work, relationships, and daily function. Strongly suggestive of major depressive disorder.

What to do: Book a medical evaluation as soon as reasonably possible. CANMAT guidelines support combination treatment (antidepressant + therapy) at this severity. If you have any thoughts of self-harm, call or text 9-8-8.

20-27

Severe depression

Severe symptom burden. Highly likely to meet criteria for major depressive disorder, often with significant functional impairment and elevated suicide risk.

What to do: Seek medical evaluation immediately — same-day if possible. Combination therapy is standard. Specialist (psychiatry) referral is appropriate. Active suicide screening is essential. If you are having thoughts of self-harm, call or text 9-8-8 now.

What a Doctor Will Do With Your PHQ-9 Score

A high PHQ-9 score is the start of the conversation, not the end. CANMAT and AAFP guidelines outline what happens at evaluation:

Confirm the diagnosis via structured interview using DSM-5-TR criteria — at least 5 of 9 specific symptoms over 2 weeks, with functional impairment, and not better explained by another condition.
Screen for bipolar disorder using the MDQ (Mood Disorder Questionnaire) — about 40% of patients with depression have bipolar features that change treatment choice. Antidepressants alone in bipolar depression can trigger mania.
Rule out medical mimics — hypothyroidism, vitamin B12 deficiency, anaemia, sleep apnoea, certain medications (corticosteroids, isotretinoin), and substance use can all present as depression.
Screen for anxiety with the GAD-7 — anxiety and depression coexist in 20-70% of cases.
Assess suicide risk in detail — beyond question 9, including ideation, plan, intent, means, and protective factors.
Discuss treatment options — CBT, IPT, SSRIs/SNRIs, combination therapy, or watchful waiting depending on severity, prior response, and preference.

CANMAT Treatment Guidance by PHQ-9 Severity

The Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes evidence-based depression treatment guidelines used across Canada. In broad strokes:

Mild (5-9): Psychotherapy (CBT, IPT, behavioural activation) or watchful waiting. Pharmacotherapy reasonable if patient prefers, recurrent depression, or persistent symptoms despite therapy.
Moderate (10-14): First-line antidepressant (SSRI such as sertraline, escitalopram, or fluoxetine; SNRI such as venlafaxine or duloxetine), evidence-based psychotherapy, or both.
Moderately severe to severe (15+): Combination treatment (antidepressant + psychotherapy) often preferred. Specialist referral if treatment-resistant or complex presentation.
Severe with suicidality or psychosis: Urgent psychiatric evaluation. Hospitalisation may be needed for safety. Antidepressants typically combined with antipsychotic in psychotic depression.

Tracking Your Score Over Time

One of the most useful features of the PHQ-9 is using it to monitor treatment response. Take it at the same time of day, every 2-4 weeks during active treatment.

5-point drop from baseline = clinically meaningful improvement
Final score <5 = remission
Stable or rising score after 4-8 weeks of an adequate antidepressant dose = consider switching, augmenting, or adding therapy
Score returning to baseline after stopping treatment = relapse — re-initiating the previously effective treatment is usually successful

A score is data, not destiny.

Depression is among the most treatable mental health conditions. CANMAT data show roughly 50-60% of patients respond to a first-line antidepressant, and over 80% achieve remission with sequential treatment (combinations, switches, or therapy add-ons). The hardest step is the first one — taking the test you just took, and reaching out.

Frequently Asked Questions

What is the PHQ-9?

The Patient Health Questionnaire-9 (PHQ-9) is a free, validated, 9-question screening tool that measures depression symptom severity over the past 2 weeks. Each question is scored 0-3, giving a total score from 0 to 27. It is the depression screening instrument most widely used in primary care worldwide and is recommended by the US Preventive Services Task Force, the American Academy of Family Physicians, and the Canadian Network for Mood and Anxiety Treatments (CANMAT).

What does my PHQ-9 score mean?

Scores 0-4 indicate no or minimal depression; 5-9 mild depression; 10-14 moderate depression; 15-19 moderately severe depression; 20-27 severe depression. A score of 10 or higher is the standard cutoff for clinically significant depression — at this threshold the PHQ-9 has sensitivity around 88% and specificity around 88% for major depressive disorder.

Is the PHQ-9 a diagnosis of depression?

No. The PHQ-9 is a screening tool, not a diagnostic test. A high score suggests further evaluation is needed, but only a clinician can make a diagnosis. The DSM-5-TR requires at least 5 of 9 specific symptoms (one being depressed mood or loss of interest) for at least 2 weeks, with functional impairment, and rules out other causes (medical conditions, bereavement, substance use).

What is question 9 of the PHQ-9?

Question 9 asks about thoughts of being better off dead or hurting yourself. Any non-zero answer to this question — even "several days" — should prompt clinical follow-up regardless of your total score. If you have these thoughts, please call or text 9-8-8 (Canada Suicide Crisis Helpline). You do not need to wait for a doctor.

Should I see a doctor based on my PHQ-9 score?

Yes if your score is 10 or higher (moderate or higher), or if you have any positive answer on question 9 (suicidal thoughts) at any score. Scores of 5-9 (mild) may warrant medical evaluation if symptoms are causing impairment, persisting beyond several weeks, or accompanied by red flags (substance use, anxiety, sleep problems). Scores of 0-4 typically do not need medical evaluation unless you have specific concerns.

How accurate is the PHQ-9?

A 2019 systematic review and meta-analysis pooled 36 validation studies and found the PHQ-9 at a cutoff of 10 has 88% sensitivity and 85% specificity for detecting major depressive disorder in primary care, with similar performance in mental-health and general-population settings.

How often should I retake the PHQ-9?

Take it at baseline before treatment, then every 2-4 weeks during the first 12 weeks of treatment to track response. After remission, every 1-3 months for maintenance is reasonable. A drop of 5 or more points from baseline (or final score under 5) is the typical marker of meaningful improvement.

Can I take the PHQ-9 online with a Canadian doctor?

Yes. MediNote physicians use the PHQ-9 (or the brief PHQ-2) as part of every depression consultation. After scoring, the physician follows up with a structured clinical interview, considers differential diagnoses (bipolar disorder, thyroid problems, grief), and discusses next steps — therapy, lifestyle changes, antidepressant medication, or referral. Same-day appointments, $55 CAD.

Is the PHQ-9 the same as the GAD-7?

No, they screen for different things. The PHQ-9 screens for depression. The GAD-7 screens for anxiety. They are often used together because depression and anxiety overlap in 20-70% of cases. Your physician may use both tools at a single consultation to assess your overall mental health picture.

PHQ-9 Depression Test: What Your Score Means (and What to Do Next)