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The PHQ-9 is the nine item depression scale of the Patient Health Questionnaire. The PHQ-9 is a powerful tool for assisting primary care clinicians in diagnosing depression as well as selecting and monitoring treatment. The primary care clinician and/or office staff should discuss with the patient the reasons for completing the questionnaire and how to fill it out. After the patient has completed the PHQ-9 questionnaire, it is scored by the primary care clinician or office staff.

There are two components of the PHQ-9:

• Assessing symptoms and functional impairment to make a tentative depression
diagnosis, and
• Deriving a severity score to help select and monitor treatment

The PHQ-9 is based directly on the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual Fourth Edition (DSM-IV).

For ease of use, Pfizer and others have suggested using a simpler scoring proxy system to estimate diagnostic categories. The MacArthur Initiative on Depression and Primary Care recommends using the initial two component scoring system. We also recommend regular use of a chronicity question to aid consideration of mild chronic depression (dysthymic disorder).

On the following pages we provide the listed items to assist in learning about using the PHQ-9. For more extensive training and/or consultation please contact us.

Sample PHQ-9

Guide for Making a Tentative Diagnosis

Guide for Severity Scoring

Provisional Diagnosis Table

Treatment Response Table

Reproduction Quality Blank PHQ-(Download - English version)

Reproduction Quality Blank PHQ-(Download - Spanish version)


Spitzer R, Kroenke K, Williams J. Validation and utility of a self-report version of PRIME-MD:
the PHQ Primary Care Study. Journal of the American Medical Association 1999; 282: 1737-1744. Abstract

Kroenke K, Spitzer R L, Williams J B. The PHQ-9: validity of a brief depression severity
measure. Journal of General Internal Medicine 2001; 16(9): 606-613 Abstract

Rost K, Smith J. Retooling multiple levels to improve primary care depression treatment.
Journal of General Internal Medicine 16: 644-645, 2001 PubMed Citation

Kroenke K, Spitzer RL. The PHQ-9: A new depression and diagnostic severity measure.
Psychiatric Annals 2002; 32: 509-521.

Williams JW, Noel PH, Cordes J A, Ramirez G,Pignone M. Is this patient clinically
depressed? Journal of the American Medical Association 2002; 287: 1160-1170. Abstract

Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment
outcomes with the patient health questionnaire-9. Medical Care, 2004. 42(12): 1194-201. Abstract

Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, Blanco E, Haro JM. Assessing depression
in primary care with the PHQ-9: can it be carried out over the telephone? Journal of General Internal Medicine, 2005. 20(8): 738-42. Abstract

The PHQ-9 is adapted from PRIMEMDTODAY, developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer Inc. For research information, contact Dr Spitzer at [email protected]. The names PRIME-MD® and PRIMEMDTODAY™ are trademarks of Pfizer Inc.

PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission of Pfizer, Inc. PRIME-MD ® is a trademark of Pfizer Inc.

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