PHQ-9 and GAD-7 explained: what your score really means
Your doctor hands you a short questionnaire in the waiting room, you circle some numbers, and a week later a score comes back that you are not sure how to read. The PHQ-9 and GAD-7 are the two questionnaires behind most of those numbers, one for depression and one for anxiety. They show up in primary care offices, telehealth intake forms, and the mental-health apps on your phone. This piece explains what each one measures, how the scoring works, where the cutoffs sit, and what your number actually means for the next conversation with a clinician. None of it is a diagnosis, and that turns out to be the most useful thing to understand.
What the PHQ-9 and GAD-7 actually measure
Both are short self-report questionnaires you fill out yourself, usually about the last two weeks.
The PHQ-9 is a nine-item depression screening questionnaire. Each item maps to one of the nine symptoms clinicians use to describe major depression, things like low interest, low mood, sleep changes, low energy, and trouble concentrating. You rate each from 0 (“not at all”) to 3 (“nearly every day”), so the total runs from 0 to 27. It was published in 2001 by Kurt Kroenke, Robert Spitzer, and Janet Williams, and validated against structured interviews of 580 patients (Kroenke et al., 2001).
The GAD-7 is its anxiety counterpart. Seven items, each scored 0 to 3, for a total of 0 to 21. It covers the core of generalized anxiety: feeling nervous, not being able to stop worrying, restlessness, and irritability. It was published in 2006 by the same group with Bernd Löwe (Spitzer et al., 2006).
Both are free. Pfizer released them without copyright or charge, which is why your clinic, your telehealth app, and plenty of websites can hand them out at no cost.
How PHQ-9 scoring works
Add up the nine answers and you land in one of five severity bands.
| PHQ-9 score | Severity band |
|---|---|
| 0–4 | Minimal |
| 5–9 | Mild |
| 10–14 | Moderate |
| 15–19 | Moderately severe |
| 20–27 | Severe |
The bands are descriptive, not verdicts. A score of 6 does not mean “you have mild depression” as a label. It means your answers, this fortnight, landed in the mild range, and that is worth noticing if it is new for you or trending up. PHQ-9 scoring is most useful when you repeat it over time and watch the direction of travel, the same way a single blood pressure reading matters less than the trend.
How GAD-7 scoring works
The GAD-7 uses four bands rather than five.
| GAD-7 score | Severity band |
|---|---|
| 0–4 | Minimal |
| 5–9 | Mild |
| 10–14 | Moderate |
| 15–21 | Severe |
A normal GAD-7 score, the kind most people get on a calm week, sits in the 0–4 minimal range. The GAD-7 cutoff that clinicians watch for is 10. At that point the original study found the screen caught about 89% of people who turned out to have generalized anxiety, while correctly clearing about 82% of those who did not (Spitzer et al., 2006).
What a score of 10 actually means
On both the PHQ-9 and GAD-7, 10 is the number that earns a second look.
For the PHQ-9, a score of 10 or higher flagged major depression with about 88% sensitivity and 88% specificity in the original validation (Kroenke et al., 2001). That is why so many clinics treat 10 as the threshold to start a real conversation rather than move on.
Think of a 10 as a doorway, not a label. It does not tell you that you have a disorder. It tells you that enough is going on, often enough, that a trained person should hear about it. In 2023 the U.S. Preventive Services Task Force recommended screening all adults for depression, and for the first time recommended screening adults aged 19 to 64 for anxiety, precisely because catching these conditions early is worth the effort (USPSTF, 2023).
PHQ-9 question 9 is the one item that’s different
The ninth question on the PHQ-9 asks about thoughts that you would be better off dead, or of hurting yourself. It is scored like the others, but it is not treated like the others.
Any answer above zero is a reason to talk to someone, ideally the same day, even if your total score is otherwise low. A “yes” here does not mean you are in immediate danger, and it does not mean you have a plan. It means the question deserves a real conversation with a clinician who can ask the next ones.
If you or someone you love is thinking about self-harm right now, you can call or text 988, the 988 Suicide and Crisis Lifeline, any time, day or night.
A screen is not a diagnosis
This is the part the calculators tend to skip. The PHQ-9 and GAD-7 are screening tools, and a screen is a starting point, not a conclusion.
A depression screening questionnaire or anxiety screening test can over-count on a bad week, during grief, with a thyroid problem, after a new medication, or through a stretch of poor sleep. That is by design. Screens are built to catch more than they should so that nothing important slips through, and a clinician then sorts signal from noise. As the National Institute of Mental Health puts it, only a health professional can diagnose and treat these conditions.
So if your PHQ-9 vs GAD-7 numbers both came back high, that is not a diagnosis of two disorders. It is a useful piece of information to bring to one appointment.
When you do bring it, keep it simple. Tell your doctor your scores, when you took the screen, and one concrete example of how it is showing up, such as “I have not slept past 4 a.m. in two weeks.” If it is a parent, partner, or teenager you are worried about, you can say the same thing on their behalf, gently, using the screen as a shared starting point rather than an accusation. A weekly family health check-in is often where these shifts first become visible.
What Katika Care does about this
If you want a single place to keep these scores over time, alongside your sleep, your readings, and your family’s, Katika Care does that. You can log a PHQ-9 or GAD-7 result, watch the trend rather than a single number, and bring a clean history to your next appointment. It is free, no ads, no data resale, and works alongside Apple Health or Health Connect. You can read more on our mental health screening hub.
A number on a questionnaire is not a verdict on you. It is a prompt, and the most useful thing you can do with it is start the conversation it was designed to open.
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Frequently asked questions
What does a PHQ-9 score of 10 mean?
A PHQ-9 score of 10 puts you at the low end of the moderate band and at the threshold most clinicians use to take a closer look. In the original validation study, a score of 10 or higher caught major depression with about 88% sensitivity and 88% specificity. It is not a diagnosis. It means enough symptoms are showing up, often enough, that a professional should hear about it and ask the follow-up questions a questionnaire cannot.
Is the PHQ-9 a diagnosis?
No. The PHQ-9 is a screening tool, not a diagnostic one. It measures how many depression symptoms you have had recently and how often, which gives a clinician a starting point. A high score can come from grief, sleep loss, a thyroid issue, or a hard couple of weeks, not only depression. Only a health professional can diagnose depression, usually after a conversation that goes well beyond the nine questions.
What's the difference between the PHQ-9 and the GAD-7?
The PHQ-9 screens for depression and the GAD-7 screens for anxiety. The PHQ-9 has nine questions and scores from 0 to 27; the GAD-7 has seven questions and scores from 0 to 21. They were built by the same researchers and look almost identical, and because depression and anxiety often travel together, clinics frequently give both at once. On either one, a score of 10 or higher is the usual signal to talk with a clinician.
What is a normal GAD-7 score?
On the GAD-7, a score of 0 to 4 is the minimal range, which is where most people land on a calm week. From there, 5 to 9 is mild, 10 to 14 is moderate, and 15 to 21 is severe. There is no single 'normal' number that fits everyone, so the more useful question is whether your score is new, rising, or interfering with daily life. A 10 or higher is the point clinicians tend to act on.
What happens if I answer yes to PHQ-9 question 9?
Question 9 asks about thoughts of being better off dead or of hurting yourself. Any answer above zero is a reason to talk to someone soon, even same-day, regardless of your total score. A 'yes' does not mean you are in immediate danger or that you have a plan; it means the question deserves a real conversation with a clinician trained to ask the next ones. If the thoughts are present right now, call or text 988 at any time.