PHQ-9 and GAD-7 Scores Explained: What Your Numbers Mean

The PHQ-9 is a nine-question depression questionnaire scored from 0 to 27, and the GAD-7 is a seven-question anxiety questionnaire scored from 0 to 21. On the PHQ-9, scores of 5, 10, 15 and 20 mark the thresholds for mild, moderate, moderately severe and severe depression; on the GAD-7, scores of 5, 10 and 15 mark mild, moderate and severe anxiety.

A score is a measure of how much you have been bothered by symptoms, not a diagnosis. A score of 10 or more on either questionnaire is the usual signal that a clinician should take a closer look, and the closer look, a clinical evaluation, is what decides whether you have a depressive or anxiety disorder.

How the two questionnaires are built

Both questionnaires come from the same research group and work the same way. Each item names a symptom, and you rate how often it has bothered you on a four-point scale from "not at all" (0) to "nearly every day" (3). Your total is simply the sum of the items.

The PHQ-9 is the depression module of the Patient Health Questionnaire. Its nine items track the nine symptom criteria for major depression in the DSM, and it asks about the past two weeks. After the nine items, it adds one more question: how difficult these problems have made it to work, take care of things at home or get along with other people. That last question is not added to the score, but clinicians pay attention to it because impairment is part of every diagnosis.

The GAD-7 was developed in 15 primary care clinics to identify probable cases of generalized anxiety disorder and rate its severity. Although it was designed around generalized anxiety, a later review by its developers found it also performs well for detecting panic disorder, social anxiety disorder and post-traumatic stress disorder. Its two opening items are used on their own as the GAD-2, just as the first two PHQ-9 items form the PHQ-2; on both short versions, 3 or more is the usual cut point.

What your PHQ-9 score means

The severity bands below come from the original validation study of 6,000 patients in primary care and obstetrics-gynecology clinics. Use them as a rough map of symptom burden, not as a verdict.

In that original study, a score of 10 or more had a sensitivity of 88% and a specificity of 88% for major depression when checked against an interview by a mental health professional. A much larger 2019 individual-participant meta-analysis, covering 58 studies and 17,357 people, again found that a cut-off of 10 or above gave the best balance, with a pooled sensitivity of 0.88 and specificity of 0.85 against semistructured clinical interviews. The same analysis found the PHQ-9 may be less specific in younger patients than in older ones, but concluded that the cut-off of 10 can be used regardless of age.

The original authors also called scores of 10 to 15 a "gray zone". In their sample, where 7% of patients had major depression, only 31% to 51% of people scoring at or above cut points from 9 to 15 actually had it. That is why a moderate score is a reason for a conversation, not a label. For what the treatment conversation can include, see depression treatment options compared.

What your GAD-7 score means

In the 2006 development study, the chosen cut point gave a sensitivity of 89% and specificity of 82% for generalized anxiety disorder. Later research has been less flattering. A 2025 Cochrane review of 48 studies and 19,228 participants found that, at a cut-off of 10, the GAD-7 had a summary sensitivity of 0.64 and specificity of 0.91 for generalized anxiety disorder, and a sensitivity of only 0.48 for any anxiety disorder. The reviewers called their estimates "rough averages" because the studies varied so much.

In plain terms: a GAD-7 of 10 or more is a fairly reliable sign that something deserves attention, but a score under 10 does not rule out an anxiety disorder. If your life is shrinking around worry, panic or avoidance, say so even if your number looks low. What generalized anxiety disorder looks like and how anxiety treatments compare are covered elsewhere in this guide and on the blog.

Item 9: the question about thoughts of death or self-harm

The ninth PHQ-9 item asks how often you have been bothered by thoughts that you would be better off dead or of hurting yourself in some way. In the original scoring rules, this is the one symptom that counts toward a diagnosis if it is present at all, regardless of how often. The U.S. Preventive Services Task Force notes that instruments such as the PHQ-9 include a question about suicidal ideation.

A large health-system study linked 207,265 questionnaires from 84,418 outpatients to later records. Over the following year, the risk of a suicide attempt rose from 0.4% among people who answered "not at all" on item 9 to 4% among those who answered "nearly every day", and the answer remained a strong predictor after accounting for overall depression severity. The authors also found that the excess risk built over several days and kept growing for months, which they read as an enduring vulnerability rather than a short-term crisis.

Two practical points follow. First, any answer above zero on item 9 deserves a direct conversation with a clinician, even if your total score is low; a total score cannot "cancel out" that item. Second, most people who endorse item 9 do not go on to make an attempt (in the study above, the one-year risk was 4% even among those answering "nearly every day"), so a positive answer is a reason for careful follow-up and a safety plan, not for panic. Clinicians usually follow a positive answer with questions about intent, plans, access to means and reasons for living, which is the structure the American Psychiatric Association recommends for an initial evaluation.

If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Screening is not diagnosis

The Task Force recommends screening all adults for depression (grade B), and screening adults aged 64 and younger for anxiety disorders (grade B), while finding the evidence insufficient for anxiety screening in adults 65 and older. For adolescents aged 12 to 18, it recommends screening for major depressive disorder and names the PHQ-9 and an adolescent version, the PHQ-A, among the instruments used. In every case the Task Force is explicit that a positive screen should lead to further assessment to confirm the diagnosis; for anxiety it says a confirmatory diagnostic assessment is needed.

The PHQ-9's own authors made the same point in 2001: before making a diagnosis, the clinician is expected to rule out physical causes of depression, normal bereavement and a history of mania. Each of those can produce a high score:

• Physical illness and medications. Thyroid disease, anemia, sleep apnea and some medicines cause fatigue, poor sleep and low concentration, which the questionnaire counts as depressive symptoms. See medical conditions to rule out before a psychiatric diagnosis.
• Grief. A recent loss can produce a high score that reflects mourning rather than a depressive disorder.
• Bipolar disorder. The PHQ-9 asks only about depressive symptoms. A person with past episodes of elevated mood can score exactly like someone with unipolar depression, and the treatment differs.
• Overlap with anxiety. Restlessness, poor sleep and trouble concentrating appear on both questionnaires, so a high score on one often comes with a high score on the other.

A full psychiatric evaluation covers these and more. How it differs from formal psychological testing is explained in psychiatric evaluation vs psychological testing.

Using scores to track treatment

The more valuable use of these questionnaires may be after diagnosis. Measurement-based care means filling out the same brief scales at regular visits and using the results to guide decisions. A 2017 review of 51 articles found that nearly all randomized trials with frequent, timely feedback of patient-reported symptoms to the clinician during medication management or psychotherapy improved outcomes, while one-time screening and infrequent measurement did not. The American Psychiatric Association's guideline on evaluating adults likewise suggests using quantitative measures of symptoms, functioning and quality of life.

How much change matters? In a study of 434 older adults in a depression treatment trial, the minimal clinically important difference for an individual on the PHQ-9 was estimated at 5 points. The developers describe sensitivity to change as well established for the PHQ-9 and emerging, but not yet definitive, for the GAD-7.

A worked example

Imagine a PHQ-9 of 17 at the first visit. Six weeks into treatment it is 14: lower, but a 3-point drop is within the range that could be day-to-day noise. At twelve weeks it is 8, a 9-point fall and comfortably beyond the 5-point threshold. If item 9 was 1 at the start and 0 now, that is a separate and important change to note. If, instead, the score had stayed in the mid-teens for several months, that would be a concrete reason to revisit the plan; see signs your mental health treatment isn't working.

Getting an accurate score

• Answer for the time frame asked (the last two weeks on both the PHQ-9 and the GAD-7), not your best or worst day.
• Count how often a symptom bothered you, not whether you managed to push through it.
• Do not lower answers to item 9 because you worry about the reaction. A clinician cannot help with what is not on the page.
• Note anything that might explain symptoms: a new medication, a recent illness, a death in the family, shift work or a new baby.
• Bring older scores if you have them. A trend is more informative than a single number.
• Remember the functioning question at the end of the PHQ-9; it often tells the clinician more than one or two points on the total.

What these questionnaires cannot tell you

Online versions of both questionnaires are widely available, and taking one before an appointment is a reasonable way to organize your thoughts. Bring the result; do not treat it as the answer. If you are not sure whether your symptoms rise to the level of needing care, signs of high-functioning depression may help you put words to them.

How this fits with starting care at the practice

Dr. Lewis's practice offers psychiatric evaluation and medication management alongside psychotherapy, including CBT and DBT. Whether a particular questionnaire is used at intake or follow-up visits is something to ask on the free discovery call, where the team answers questions about care options, scheduling and insurance. If you have recent PHQ-9 or GAD-7 scores from a primary care visit, bring them; they give any clinician a useful starting point. To begin, the Patient Interest Form helps the team understand whether the practice is the right fit. The Choosing Psychiatric Care guide covers the other decisions along the way.

Frequently asked questions

Can I diagnose myself with depression using the PHQ-9?

No. The PHQ-9 was built to support a clinician's diagnosis, and its authors expected the clinician to rule out physical causes, grief and a history of mania first. A high score tells you an evaluation is worthwhile.

My PHQ-9 is low but I still feel terrible. Should I ignore it?

No. Questionnaires miss some people, and they do not capture every kind of distress. Tell a clinician what you are experiencing in your own words, and mention any thoughts of death or self-harm whatever your total score.

Why did my doctor ask me to fill out the same form again?

Repeating the same questionnaire at each visit is how clinicians track whether treatment is working. A trend across several visits says more than any single score.

Are the PHQ-9 and GAD-7 free to use?

Yes. Pfizer originally sponsored development of the PHQ-9, which is now in the public domain, and the GAD-7 form itself states that no permission is required to reproduce, translate, display or distribute it.

Does a high GAD-7 score mean I have generalized anxiety disorder?

Not necessarily. The GAD-7 also picks up panic disorder, social anxiety and PTSD, and physical conditions such as an overactive thyroid can raise it. A clinical evaluation sorts out which, if any, applies.

Is there a version for teenagers?

Yes. The PHQ-A is an adolescent version of the Patient Health Questionnaire, and the U.S. Preventive Services Task Force lists it among instruments used to screen adolescents for depression. A parent can help a teen complete it, but the teen's own answers matter most.

Sources

1. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine (Kroenke, Spitzer, Williams), 2001. pmc.ncbi.nlm.nih.gov
2. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine (Spitzer, Kroenke, Williams, Lowe), 2006. pubmed.ncbi.nlm.nih.gov
3. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry (Kroenke, Spitzer, Williams, Lowe), 2010. pubmed.ncbi.nlm.nih.gov
4. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ (Levis, Benedetti, Thombs; DEPRESSD Collaboration), 2019. pubmed.ncbi.nlm.nih.gov
5. Monitoring depression treatment outcomes with the patient health questionnaire-9. Medical Care (Lowe, Unutzer, Callahan, Perkins, Kroenke), 2004. pubmed.ncbi.nlm.nih.gov
6. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death?. Psychiatric Services (Simon et al.), 2013. pubmed.ncbi.nlm.nih.gov
7. Depression and Suicide Risk in Adults: Screening. U.S. Preventive Services Task Force, 2023. uspreventiveservicestaskforce.org
8. Anxiety Disorders in Adults: Screening. U.S. Preventive Services Task Force, 2023. uspreventiveservicestaskforce.org
9. A Tipping Point for Measurement-Based Care. Psychiatric Services (Fortney et al.), 2017. pubmed.ncbi.nlm.nih.gov
10. Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults. Cochrane Database of Systematic Reviews (Akturk et al.), 2025. pmc.ncbi.nlm.nih.gov
11. The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition. American Psychiatric Association, 2016. carelonbehavioralhealth.com
12. Depression and Suicide Risk in Children and Adolescents: Screening. U.S. Preventive Services Task Force, 2022. uspreventiveservicestaskforce.org
13. GAD-7. Health PEI (reproduction of the Spitzer, Williams, Kroenke form), n.d.. src.healthpei.ca

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.