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Patient Health Questionnaire - 9 (PHQ-9) Depression Scale
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NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure for mood/anxiety.
Supplemental - Highly Recommended: Headache, Spinal Cord Injury (SCI)* and SCI-Pediatric* (ages 12 and older), and Stroke
*Recommendations for use: Indicated for studies requiring a screening measure for depression.
Supplemental: Epilepsy, Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion), and Traumatic Brain Injury (TBI).
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
The PHQ-9 is a screening tool that is specific to depression. This 9-item measure asks participants whether and how often they have been bothered by depression related symptoms over the last two weeks.
Comments/Special Instructions
Sport-Related Concussion-Specific: Well validated, widely used screening instrument for depression symptoms. Although not a diagnostic instrument, at higher cut-off levels there is a high correlation with diagnostic interviews.
NeuroRehab-Specific: The validity of the PHQ-9 as a screen for major depressive disorder has been established in multiple neurological samples including stroke, TBI and SCI.
Age Range: 13 years and older
Scoring and Psychometric Properties
Scoring: 9 items are scored on a scale of 0 to 3, resulting in a total score of 0 to 27 for depression severity:
0 = not at all
1 = several days
2 = more than half the days
3 = nearly every day
Total Scores: (Kroenke, et al., 2001)
0-4 indicates minimal depression (no treatment action required)
5-9 indicates mild depression (watch and repeat PHQ-9 at follow-up)
10-14 indicates moderate depression (treatment plan and counseling recommended and/or pharmacotherapy)
15-19 indicates moderately severe depression (active treatment with pharmacotherapy and/or psychotherapy)
20-27 indicates severe depression (Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management)
Psychometric Properties: The PHQ-9 is a valid screening measure for major depressive disorder in people with SCI assessed during their initial inpatient rehabilitation. At a slightly higher cutoff than usual (greater than or equal to 11), the PHQ-9 has a sensitivity of 100% and a specificity of 84% and met stringent criteria for an adequate diagnostic test (Youden criterion). The PHQ-9 has also been found to be sensitive to change in the context of a clinical trial of antidepressant treatment as the "gold standard" Hamilton Depression Rating Scale and some other measures.
Administration: 1 to 3 minutes; paper and pencil.
SCI-specific notes: This instrument has excellent internal consistency, as it showed promise as a tool with which to identify probable Major Depressive Disorder in people with SCI (Bombardier et al., 2004).
A shortened version of the PHQ-9 with just questions 1, 2 and 6 may be used to increase efficiency and reduce gender effects of the 9 item questionnaire (Graves and Bombardier, 2008).
Fann JR, Bombardier CH, Dikmen S, Esselman P, Warms CA, Pelzer E, Rau H, Temkin N. Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehabil. 2005;20(6):501-511.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
LÖwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care. 2004;42(12):1194-1201.
Maizels M, Smitherman TA, Penzien DB. A review of screening tools for psychiatric comorbidity in headache patients. Headache. 2006;46 Suppl 3:S98-S109.
Bombardier CH, Kalpakjian CZ, Graves DE, Dyer JR, Tate DG, Fann JR. Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil. 2012;93(10):1838-1845.
Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG. Symptoms of major depression in people with spinal cord injury: implications for screening. Arch Phys Med Rehabil. 2004;85(11):1749-1756.
Graves DE, Bombardier CH. Improving the efficiency of screening for major depression in people with spinal cord injury. J Spinal Cord Med. 2008;31(2):177-184.
deMan-van Ginkel JM, Gooskens F, Schepers VPM, Schuurmans MJ, Lindeman E, Hafsteindottir TB. Screening for Poststroke Depression Using the Patient Health Questionnaire. Nursing Research. 2012;61(5):333-341.
Turner A, Hambridge J, White J, Carter G, Clover K, Nelson L, Hackett M. Depression Screening in Stroke: A Comparison of Alternative Measures With the Structured Diagnostic Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Major Depressive Episode) as Criterion Standard. Stroke. 2012;43(4):1000-1005.  
Document last updated January 2022