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The PHQ-9: questionnaire, score and clinical reading

· By The Orekio team

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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 of rights, and available in many translations. From one appointment to the next, it mainly serves as a point of comparison.

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 bands from the validation study (Kroenke, Spitzer and Williams, 2001) are: 5 (mild), 10 (moderate), 15 (moderately severe), 20 (severe). A score of 10 or more is often used as the attention threshold for a major depressive episode: in that study, it corresponded to a sensitivity and a specificity of 88%.

These figures remain a marker: diagnosis stays a clinical act, made in interview. The PHQ-9 complements that interview, which keeps the final word. Any answer other than 0 to item 9, on thoughts of death or self-harm, calls for a direct assessment of suicide risk in interview.

What Orekio does with it, and what belongs to you

In Orekio, the PHQ-9 is a module you open when you judge it useful. The patient fills it in from their phone, in the French translation for France reproduced word for word. At the next appointment, you find the total score, the item-by-item detail, and the previous administrations one below the other.

Orekio displays the score and the detail of the answers, and stops there. It shows no severity band, compares to no norm and gives no signal, including on item 9. This choice is deliberate: Orekio is designed as a digital logbook, not as a medical device (see About). The clinical reading, the course of action and the assessment of suicide risk belong entirely to you.

Concretely, the PHQ-9 in Orekio makes a data point available, and vigilance remains yours: it is you who organise the framework around it (rhythm of administrations, interview, safety plan where appropriate).

In practice

A first administration, at the start of care, gives a baseline. Many practitioners have it repeated every two to four weeks, during a treatment or a psychotherapy, as a numerical support the patient and you look at together. It is you who set the rhythm, in consultation; Orekio simply displays the administrations one below the other.

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