> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # PHQ-9 — Patient Health Questionnaire > The standard depression severity scale. 9 items, 0–27 total, severity bands from Minimal to Severe, with Item 9 risk flagging for suicidal ideation. 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. ## 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. Pairs naturally with the [GAD-7](/clinical-templates/screening/gad-7) as the standard depression-anxiety baseline. ## 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. ## 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. ## Severity bands | Total | Severity | | ----- | ----------------- | | 0–4 | Minimal | | 5–9 | Mild | | 10–14 | Moderate | | 15–19 | Moderately severe | | 20–27 | Severe | 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 **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. ## 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](/clinical-templates/screening/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](/clinical-templates/screening/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](/clinical-templates/screening/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](/clinical-templates/child/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 The companion anxiety measure — administered alongside PHQ-9 as the standard baseline. When to screen, picking between overlapping depression measures, and the risk-flag rule. The live collaborative flow you'll use when administering this measure.