What Patient Health Questionnaire (PHQ9) score indicates the need for mental health attention?

PHQ-9 Scores Requiring Mental Health Attention

A PHQ-9 score of 8 or higher indicates clinically significant depression that requires mental health attention, with increasing levels of intervention needed as scores rise. 1

PHQ-9 Scoring Thresholds and Clinical Implications

• Scores 1-7: Minimal/mild symptoms of depression; patients typically have effective coping skills and adequate social support; no further intervention required 1, 2
• Scores 8-14: Moderate depressive symptomatology; requires attention; indicates subthreshold depressive symptoms with mild to moderate functional impairment; consider consultation with psychology or psychiatry for diagnostic confirmation 1, 2
• Scores 15-19: Moderate to severe depressive symptomatology; symptoms interfere moderately to markedly with functioning; referral to psychology and/or psychiatry for diagnosis and treatment is strongly recommended 1, 2
• Scores 20-27: Severe depressive symptomatology; requires immediate intervention due to significant functional impairment 1, 3

Assessment Approach

• A phased screening approach is recommended, starting with the first two PHQ-9 items (anhedonia and depressed mood) 2
• If either of these first two items scores ≥2, complete the full PHQ-9 assessment 2
• For patients with scores ≥8, evaluate for functional impairment and consider consultation with mental health professionals 1
• Special attention should be given to item 9 regarding self-harm thoughts; the frequency and specificity of these thoughts are crucial for risk assessment 2, 1

Special Considerations

• The PHQ-9 has demonstrated strong psychometric properties across various settings with good sensitivity (88%) and specificity (88%) for major depression at a cutoff of ≥10 3
• The PHQ-9 performs better as a screening tool in primary care settings compared to secondary care settings 4
• Clinical context should be considered when interpreting scores, including symptom duration, sociodemographic factors, psychiatric comorbidities, and social support 1
• Despite its utility, the PHQ-9 is often underutilized for monitoring patients being treated for depression in primary care settings 5

Intervention Recommendations Based on PHQ-9 Scores

• For scores 8-14: Consider low-intensity interventions such as guided self-help based on cognitive behavioral therapy, structured physical activity programs, or pharmacologic treatment as appropriate 2
• For scores ≥15: High-intensity interventions delivered by licensed mental health professionals are recommended, including individual psychological therapy using treatment manuals that incorporate cognitive change, behavioral activation, and biobehavioral strategies 2, 1
• For any patient identified as at risk of harm to self or others (regardless of total score): Immediate referral for emergency evaluation by a licensed mental health professional is required 2

Common Pitfalls to Avoid

• Failing to complete the full PHQ-9 when initial screening items suggest depression 2
• Omitting the self-harm item (item 9) from assessment, which may artificially lower scores and miss critical risk information 2
• Using the same cutoff score across all clinical settings without considering the context-specific optimal thresholds 4
• Not conducting follow-up assessments with the PHQ-9 to monitor treatment response in patients with elevated scores 5