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.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.
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
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
Severity bands
A score of 10 or higher is the screening threshold widely cited for
further evaluation of major depression (Kroenke 2001).
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.Item 9 — suicidal ideation
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.Using it in a Canadian practice
No licence, no fee. The PHQ-9 is free to use in clinical practice and you don’t need permission to administer it — whether you send it ahead of a session or run it on the call. Your client’s answers stay in Canada. A completed PHQ-9 is health information about a named person. The answers are stored encrypted in a Montreal data centre and land in that client’s chart against the session they belong to. Nothing goes to an outside service to be scored — the severity band and the Item 9 flag are computed from the answers themselves. Getting it into your file of record. The scored result copies out formatted for a progress note, so it pastes into Jane, Owl or whatever holds the record. You’re not retyping a total, and the band travels with it. What you document is yours. Rivet flags a positive Item 9 and timestamps when the response came in. What your College expects you to record about that — and what you do next — sits with you. English only. Validated French translations of the PHQ-9 exist, but the version here is English. If you practise in French, you’ll be working from your own copy for that client.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.
PHQ-9 vs the other depression measures
The PHQ-9 is the default. The others earn their place in specific situations.- vs QIDS-SR-16 — the QIDS spreads sixteen items across the DSM symptom domains, giving sleep four items and appetite four where the PHQ-9 gives each one. Reach for it when you want that resolution; reach for the PHQ-9 when you want the measure a referrer will recognise without explanation.
- vs CES-D-R — twenty items, a past-week frame rather than two weeks, and two separate suicidality items instead of the PHQ-9’s single Item 9. Often chosen for continuity when a client already has older CES-D scores in their file.
- vs WHO-5 — five items about well-being rather than symptoms. Useful with a client who bristles at problem-framed questionnaires, but a low WHO-5 is the signal to follow up with a PHQ-9, not a substitute for one.
- vs PHQ-A — the same nine symptoms in adolescent wording, for ages 11–17, scored against a cutoff of 11 rather than 10. Use it for anyone under 18.
- vs the BDI-II — the Beck Depression Inventory is a licensed instrument sold by Pearson and paid for per use. Rivet doesn’t include it, and that was deliberate: the library was built from measures you can administer without a per-administration fee. If your practice already licenses the BDI-II, you’ll keep running it wherever you licensed it.
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.Related articles
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.