The PHQ-9: questionnaire, score and clinical reading
· 2 min read · By The Orekio team
Updated
The PHQ-9 (Patient Health Questionnaire, 9-item version) is one of the most widely used self-report questionnaires for exploring depressive symptoms. It is short, free to use, and available in many validated languages. In a follow-up, it mainly serves as a point of comparison from one appointment to the next.
What it measures
The 9 items map onto the symptom criteria for a depressive episode: mood, loss of interest, sleep, energy, appetite, concentration, guilt, slowing or agitation, and thoughts of death or self-harm. For each one, the patient indicates the frequency over the past two weeks:
- 0 — not at all
- 1 — several days
- 2 — more than half the days
- 3 — nearly every day
The total score ranges from 0 to 27.
What the thresholds say
The commonly cited bands are: 5 (mild), 10 (moderate), 15 (moderately severe), 20 (severe). A score of 10 or above is often used as an attention threshold for major depressive disorder.
These numbers are not a diagnosis. The PHQ-9 is a screening and monitoring tool: it complements the clinical interview, it does not replace it. Item 9, on thoughts of death or self-harm, calls for a direct assessment by the practitioner whatever the answer.
What Orekio does with it — and doesn't
In Orekio, the PHQ-9 is a module the practitioner unlocks when they judge it useful. The patient fills it in from their phone, in a version faithful to the validated questionnaire. At the next appointment, the practitioner finds the total score, the item-by-item detail, and the history of administrations.
Orekio does not interpret this result. The app shows no label ("moderate depression"), does not compare the score to a norm, and triggers no alert — including on item 9. This is a deliberate choice: Orekio holds the status of a digital care journal, outside the scope of Regulation (EU) 2017/745 on medical devices (see the About page). The clinical reading, the course of action and the assessment of suicide risk are entirely the practitioner's responsibility.
In practice, this means the PHQ-9 in Orekio does not substitute for any vigilance: it makes a data point available, and it is up to the practitioner to organise the framework around it (frequency of administration, interview, safety plan where appropriate).
In practice
One administration before the first appointment gives a baseline. Repeated every two to four weeks, the PHQ-9 lets you track change under the effect of a treatment or psychotherapy, with a numerical support the patient and practitioner look at together. The GAD-7 (anxiety) and sleep-diary modules are often used alongside it.