PHQ-9

The Patient Healthcare Questionnaire-9 (PHQ-9) helps assess depression, one of the most widespread and harmful mental health disorders, affecting almost six percent of adults worldwide.

Given its widespread impact, therapists require efficient and reliable assessment measures to help them with diagnosis and monitoring. Here is what you need to know about the PHQ-9.

Summary

• The PHQ-9 is a quick, evidence-based depression screening tool that helps therapists assess symptom severity and monitor progress over time. Download my free PHQ-9 screener.
• Therapists can use PHQ-9 results to guide treatment planning, determine appropriate levels of care, and track changes in depressive symptoms throughout therapy.
• While the PHQ-9 is highly reliable and easy to administer, it should be used alongside clinical interviews and other assessment tools rather than as a standalone diagnosis.
• Modern EHR platforms like TheraPlatform can automate PHQ-9 scoring, securely store results, and visually track client progress to streamline care.

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What is the PHQ-9?

The PHQ-9 is a nine-item self-report measure whose items mirror the criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Respondents rate each item on a four-point scale based on symptom frequency. Completion typically takes about two to five minutes. The PHQ-9 is free and readily accessible online.

What does the PHQ-9 measure?

Each question on the PHG-9 typifies one symptom of major depression as represented in the DSM-5. Although brief, it is a valid indicator of the presence of depressive disorder, as well as its severity. Assessment focuses on the individual’s feelings over the past two weeks. Additionally, the last question asks about suicide and self-harm, which can indicate a crisis situation that needs immediate attention.

How to administer the PHQ-9

The PHQ-9 is simple to administer. The instructions are included and easy to understand. It is designed to be self-administered, but therapists can also give it verbally. The advantage of verbal administration is the availability of immediate therapist follow-up to certain responses.

The PHQ-9 can be taken anytime, including at home. Several practice management platforms, such as TheraPlatform, allow you to take it online through their secure client portal. It is usually implemented when information obtained at intake may indicate the presence of depression.

Clinician’s note: If a therapist chooses to administer the PHQ-9 verbally, it is important to give the whole measure first (and exactly as written) before discussing it. Otherwise, you may interfere with its validity and reliability.

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PHQ-9 scoring and interpretation

• It takes approximately three to five minutes for a clinician to score the PHQ-9 by hand. Several therapy EHRs do it automatically.
• Clients rate the severity of the nine listed symptoms over the past two weeks on a scale of 0 (not at all) to 3 (nearly every day).

The total score suggests the level of depression:

0-4: No depression. Further treatment for depression is generally not required.

5-9: Mild depression. Further monitoring is needed for possible treatment.

10-14: Moderate depression. Probably requires weekly outpatient therapy and/or medication intervention.

15-19: Moderately severe depression. Outpatient therapy services are required, possibly multiple times a week. Medication is almost surely recommended. May also need something more intensive, such as day treatment.

20-27: Severe depression. Intensive treatment interventions are warranted. May require inpatient services.

Clinician’s note: If question nine (on suicidality) is rated in the affirmative, the therapist needs to follow up, even if the overall score does not seem to be a cause for concern.

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PHQ-9 benefits and limitations

The PHQ-9 has the following pros and cons:

Benefits of the PHQ-9

• User-friendly: It consists of only nine questions that align with DSM diagnostic criteria, making it fast for patients to complete and easy for clinicians to score.
• Valid and reliable measure: It is a well-validated and reliable tool for measuring the severity of depressive symptoms.
• Diagnostic aid: If a therapist is unsure about a clinical diagnosis of depression, the PHQ-9 can be used to bolster their assessment.
• Free and accessible: The tool is available to clinicians and clients at no cost.
• Includes suicide risk detection: The last item specifically addresses suicidal ideation, providing a safety screening alert.

PHQ-9 limitations

• Not a conclusive diagnostic tool: The PHQ-9 is a screening instrument and is not to be used as the sole resource for the diagnosis of depression. A clinical interview and other assessment measures should be used to form a complete diagnosis.
• False positives: Although a valid and reliable tool, the PHQ-9 can produce false-positive results, leading to potential over-diagnosis.
• Self-report: Relying on self-reports means results can be distorted by a client's lack of insight or bias.
• Misunderstanding: Some people may find certain questions difficult to interpret on their own, especially because some items (e.g., questions 6 and 8) ask about two things at once.

The PHQ-9 for treatment planning and progress tracking

The PHQ-9 is a valuable tool for initial assessment as well as tracking progress:

Intake administration

The therapist may administer it before, during, or after intake if depression is suspected. The outcome gives the clinician and client a clinical picture of the severity of the depression-related symptoms. The clinician can then use this information to assist with developing and designing an individualized treatment plan for the client.

Progress tracking

Because of the ease of administration and scoring, it is possible to take the PHQ-9 multiple times throughout treatment to track client progress on depressive symptoms. Administering the PHQ-9 during the course of treatment provides the therapist and client with information regarding changes in symptom severity.

The clinician can use the client’s answers to guide a clinical discussion on the progress in treatment and to address any need for changes in interventions or the frequency of sessions.

For example, if the PHQ-9 indicates an improvement in symptoms, it may be appropriate for the therapist and client to discuss stepping down the frequency of sessions.

In contrast, if the score indicates an increase in the severity of symptoms, then it might warrant a discussion of what needs to be done differently in treatment.

Improving mental health assessment notes with EHR software

EHR software and practice management tools, such as TheraPlatform, offer numerous advantages in creating accurate, efficient, and organized notes.

Top 7 benefits of using EHR for notes management

Manually writing and storing notes can be cumbersome for many therapists. That process can be further exacerbated by simple document requests that include locating, faxing or scanning documents.

Features like customizable templates, secure storage, easy sharing, duplication, electronic signatures, and efax integration, streamline the note process, optimizing therapy documentation and workflows.

• Consistent notes with template library: EHRs equipped with a library of note templates enable therapists to create standardized and concise notes quickly. This feature ensures consistency across notes, making it easier to review client progress. Additionally, EHRs provide centralized storage and management of notes, enhancing accessibility and organization.

Screenshot of TheraPlatform’s built-in assessment template library. Assessments are one of dozens of types of templates that can be used as is or modified to meet the needs of a therapist in private practice.

• Customizable notes: Not all EHRs offer customizable note templates tailored to therapists' unique needs. However, with a robust and user-friendly note template builder, therapists can customize note templates to align with their preferred note-taking style. This flexibility allows for efficient data entry, whether therapists prefer separating sections or using a single note field or checkboxes for mental status or techniques.

Screenshot of TheraPlatform's notes builder. Use existing templates or create your own with new fields like pick lists, checkboxes, and buttons.

• HIPAA-compliant note storage: EHRs prioritize data security by implementing bank-level encryption to safeguard notes and other client information. TheraPlatform, for instance, ensures HIPAA compliance by offering signed, legally-binding Business Associate Agreements to protect Protected Health Information (PHI) between compliant entities.
• Seamless note sharing with clients: Clients may request access to their notes to better understand their treatment or keep them for record-keeping purposes. Using an EHR, therapists can securely share notes with clients, saving time compared to paper-based practices. TheraPlatform, a HIPAA-compliant EHR for therapists, facilitates secure note sharing with clients.

Screenshot of the popular DAP note template created with TheraPlatform. Built-in templates allow for consistent and standardized note-taking.

• Duplicate notes: In cases where the data remains the same across multiple sessions, duplicating notes can save time. This feature is particularly useful when clients exhibit repetitive behaviors or show minimal progress, allowing therapists to refer back to previous notes for accurate documentation.
• Client signatures made easy: EHRs streamline the process of requesting client signatures. TheraPlatform's Pro and Pro Plus plans enable therapists to request electronic signatures directly on notes. Clients can conveniently download and print the documents requiring their signatures.
• Easier faxing: TheraPlatform offers efax integration as an add-on feature, eliminating the need for toggling between multiple services. This integrated solution allows therapists to send and receive documents, including notes, via fax directly from TheraPlatform. Additionally, received faxes can be easily filed under the respective client's charts.

Additional tools and outcome measures to help with data collection and progress monitoring

Therapists can also take advantage of EHRs (such as TheraPlatform) that offer integrations with Wiley treatment planners to ensure consistent data collection on progress from session to session. The best part about partnering with a modern EHR is the time you save on formulating the actual notes and scoring.

Save time with automatically scored outcome measures

Mental health therapists can use outcome measures to document progress and track key clinical indicators to help providers make data-driven decisions and improve client communication and outcomes. Additionally, outcome measures help therapists adhere to compliance requirements and provide necessary documentation to support reimbursement.

While outcome measures clearly provide benefits to both clients and therapists, they can be time-consuming, especially if clinicians score responses manually. However, many aspects of outcome measures can be automated through an EHR like TheraPlatform:

• Sending measurements: Common assessments such as the PHQ-9 or GAD-7 can be automatically sent to clients and stored in their records, or they can be scheduled in regular intervals.
• Auto-scoring: TheraPlatform automatically scores and sums totals for common outcome measures.
• Report building and analysis: Results can be analyzed over time, with visual charts showing progress on rates of severity and session-to-session progress.

Screenshot of a scored outcome for the PHQ-4 on TheraPlatform’s EMR

By regularly using these measures, therapists can gain valuable insights, tailor interventions, and improve client outcomes while demonstrating the effectiveness of their care without manual entry.

What is Wiley Treatment Planner? 

Screenshot of TheraPlatform’s Wiley Treatment Planner integration. Wiley offers thousands of prewritten, evidence-based treatment goals, objectives, and interventions for mental health therapists in private practice.

Wiley Treatment Planner is a widely used clinical resource designed to help mental health professionals and other therapists efficiently create treatment plans for their clients. In addition to treatment plans, the company also provides prewritten therapy notes for some diagnostic codes. It is part of the "PracticePlanners" series published by Wiley.

Features of Wiley Treatment Planner include:

• Prewritten, evidence-based treatment goals, objectives, and interventions
• Treatment planners tailored to specific populations and problems, including adults, children, adolescents, couples, families, addictions, and more
• Alignment with the diagnostic criteria from the DSM-5 and ICD-10
• Prewritten therapy notes 

Is there an online version of Wiley Treatment Planner and how can I get the Wiley Treatment Planner?

Wiley Treatment Planner company partnered with a select number of EHRs for mental health providers to make treatment planners available online. TheraPlatform’s EHR offers the Wiley Treatment Planner as an add-on for both assessment and treatment plans and therapy notes, such as notes. You can edit prewritten notes and add your own with any therapy template on TheraPlatform.

Streamline your practice with One EHR

• Scheduling
• Flexible notes
• Template library
• Billing & payments

• Insurance claims
• Client portal
• Telehealth
• E-fax

Learn More

References

B.C. Government. Patient Health Questionnaire (PHQ-9). https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/depression_patient_health_questionnaire.pdf

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

TheraPlatform. Depression ICD-10. https://www.theraplatform.com/blog/568/depression-icd-10

World Health Organization (2025). Depressive disorder. https://www.who.int/news-room/fact-sheets/detail/depression#:~:text=Women%20are%20more%20likely%20to%20have%20depression,people%20in%20the%20world%20have%20depression%20(1)