PHQ-9 scores range from 0 to 27, with 5, 10, 15, and 20 representing thresholds for mild, moderate, moderately severe, and severe depressive symptoms, respectively. The most common screening threshold is ≥ 10.
The PHQ-9 is the nine item depression scale of the patient health questionnaire.* It is one of the most validated tools in mental health and can be a powerful tool to assist clinicians with diagnosing depression and monitoring treatment response. PHQ-9 Scoring Instructions and Interpretation Scoring. Add the scores indicated for each item in each column and add the columns together for the Total score. Interpretation of Total Score and Treatment Suggestions. Score Range Treatment. 0-4 Normal No action 5-9* Mild Watchful Waiting; Consider scheduling a follow-up visit in a few weeks, patient education, or discuss counseling as an option 10-14 Mild-Moderate Patient education, counseling or active treatment 15-19 Moderate Active greater than or equal to 10) pre-treatment to a non-depressed range (defined as scores less than or equal to 9) post-treatment. Improvement in scores should be 50% or greater of the patients’ pre- Count the number (#) of boxes checked in a column. Multiply that number by the value indicated below, then add the subtotal to produce a total score. The possible range is 0-27. Use the table below to interpret the PHQ-9 score. • A total PHQ-9 score > 10 (see below for instructions on how to obtain a total score) has a good sensitivity and specificity for MDD. To use the PHQ-9 to aid in the diagnosis of dysthymia: • The dysthymia question (In the past year…) should be endorsed as “yes.” How to Score the PHQ-9, Planning And Monitoring Treatment. Question One • To score the first question, tally each response by the number value of each response: Not at all = 0 Several days = 1 More than half the days = 2 Nearly every day = 3 • Add the numbers together to total the score. • Interpret the score by using the guide listed below: Interpreting the score Each question is given a numerical value between 0 and 3. Total scores range from 0 to 27. The total score can indicate the potential severity of depression. Total Score Depression Severity 1–4 Minimal depression 5–9 Mild depression 10–14 Moderate depression 15–19 Moderately severe depression 20–27 Severe depression
Add together column scores to get a TOTAL score. 4. Refer to the accompanying PHQ-9 Scoring Card to interpret the TOTAL score. 5. Results may be included in patients’ files to assist you in setting up a treatment goal, determining degree of response, as well as guiding treatment intervention. PHQ-9 SCORING CARD FOR SEVERITY DETERMINATION
Scoring and Interpretation: GAD-2 Score* Provisional Diagnosis 0-2 None 3-6 Probable anxiety disorder GAD-7 Score Provisional Diagnosis 0-7 None 8+ Probable anxiety disorder *GAD-2 is the first 2 questions of the GAD -7 . References: • Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the The PHQ-2 is not designed to establish a diagnosis of depression, but is used to determine whether the rest of the questions in the PHQ-9 are to be asked. PHQ-2 scores range from 0 to 6, with 3 as the typical score to trigger asking the remaining questions of the PHQ-9.
Interpreting the score Each question is given a numerical value between 0 and 3. Total scores range from 0 to 27. The total score can indicate the potential severity of depression. Total Score Depression Severity 1–4 Minimal depression 5–9 Mild depression 10–14 Moderate depression 15–19 Moderately severe depression 20–27 Severe depression
PHQ-9 Score Treatment Response Treatment Plan Drop of ≥ 5 points from baseline Adequate No treatment change needed. Follow-up in four weeks. Drop of 2-4 points from baseline. Probably Inadequate Possibly no treatment change needed. Share PHQ-9 with psychological counselor. Drop of 1-point or no change or increase. Inadequate Jul 01, 2016 · This is generally a score of 10 or above and/or a positive answer on question 9 of the PHQ 9, which is a screening for suicidal symptoms. 3 4 A workflow will need to be developed to identify appropriate staff responsibilities and procedures for responding to these scores. Apr 09, 2019 · A conventional PHQ-9 meta-analysis from 2015 (36 studies, 21 292 participants) evaluated sensitivity and specificity for cut-off scores 7-15 by combining accuracy results for each cut-off score that were published in included primary studies.8 Pooled sensitivity for the standard cut-off score of 10 was 0.78 (95% confidence interval 0.70 to 0.84 Scoring of PHQ-9 . The scoring of PHQ-9 is very easy. It has 4 responses that range from “0” (Not at all) to “3” (nearly every day). The scores are then helpful in identifying the varying levels of depression. The score range is from 0 -27. If the score is above 10, it highlights presence of depression. The PHQ-A (PHQ-9 modified for Adolescents) takes less than five minutes to complete and score. If patient decides to complete the PHQ-A by himself/herself, he/she should be left alone to complete the PHQ-A in a private area, such as an exam room or a private area of the waiting room. TOTAL SCORE Enter the total score as a two-digit number. The total possible BIMS score ranges from 00 to 15. 13 — 15: cognitively intact 08 - 12: moderately impaired 00 — 07: severe impairment DHMH Rev 10/1 1