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The PHQ-9 is the dominant standardized depression-severity screening instrument in primary care, mental health, and outcome-informed therapy. If you administer one depression measure, it’s almost always this one.

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What it measures

Depression severity over the last two weeks, mapped to DSM-5 Major Depressive Disorder criteria. Nine symptom items — anhedonia, depressed mood, sleep, fatigue, appetite, guilt/worthlessness, concentration, psychomotor agitation/retardation, and suicidal ideation. Each item is rated on a 4-point frequency scale. A tenth item captures functional impairment but is not included in the total score — it’s there for context, not for the band.

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When to use it

  • Intake. As a baseline measure on the first session — typically sent async ahead of time.
  • Every 2–4 weeks during treatment. To track response without screening burnout.
  • Pre/post a discrete intervention. Around a CBT protocol, an EMDR reprocessing target, or a medication change.
  • Discharge. Outcome documentation.
Pairs naturally with the GAD-7 as the standard depression-anxiety baseline.

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How clients fill it

Two minutes on a phone, slightly less on a laptop. The 2-week stem prompt appears at the top — “Over the last 2 weeks, how often have you been bothered by any of the following problems?” — followed by the nine items, each with the same four-option frequency scale:
  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Item 10 (functional impairment) uses a different four-option scale (Not difficult at all → Extremely difficult) and is shown for context.

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How Rivet scores it

Each of the four response options carries a score:
  • Not at all → 0
  • Several days → 1
  • More than half the days → 2
  • Nearly every day → 3
The total is the sum of items 1–9. Item 10 is not summed into the total. Range: 0–27. The score appears live in your scoring pill as the client answers — you see the running total and the current severity band update with each tap.

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Severity bands

TotalSeverity
0–4Minimal
5–9Mild
10–14Moderate
15–19Moderately severe
20–27Severe
A score of 10 or higher is the screening threshold widely cited for further evaluation of major depression (Kroenke 2001).

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Clinical change

A drop of 5 points on the PHQ-9 is the convention most often cited as clinically meaningful improvement (per the follow-up literature around Kroenke et al.). This is a clinical convention, not a Rivet calculation — the in-session scoring pill shows the current total only. If you want to compare two PHQ-9s administered weeks apart, you’re reading them off your chart.

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Item 9 — suicidal ideation

Any positive answer on Item 9 warrants suicide-risk follow-up regardless of the total score. A PHQ-9 of 6 with Item 9 answered “Several days” matters more than a PHQ-9 of 22 with Item 9 at zero.Rivet surfaces a flag in the scoring pill when Item 9 is above zero. The clinical decision about what to do next — safety planning, C-SSRS, consult, hospitalization, all of the above — is yours.
Item 9 reads: “Thoughts that you would be better off dead, or of hurting yourself in some way.” A “Several days” answer means the thoughts were present on several days in the past two weeks, which is a clinically significant signal even at low frequency.

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When NOT to use it

  • Clients under 18. The PHQ-9 was validated in adults. For adolescents, the PHQ-A is the age-appropriate version.
  • As a sole diagnostic instrument. The PHQ-9 is a screening measure. A score of 22 doesn’t diagnose Major Depressive Disorder; the clinical interview does.
  • As an outcome measure on its own without paired anxiety screening. Comorbidity is the rule, not the exception — pairing with GAD-7 catches the common presentation that PHQ-9 alone would miss.

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Citation

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. Copyright Pfizer Inc. Explicitly released by Pfizer in 2010 for free public use without restriction. Rivet preserves the canonical item wording verbatim — paraphrase would break instrument validity, because the published severity bands only apply to the published item wording.

GAD-7

The companion anxiety measure — administered alongside PHQ-9 as the standard baseline.

Screening overview

When to screen, picking between overlapping depression measures, and the risk-flag rule.

Filling a template in-session

The live collaborative flow you’ll use when administering this measure.