The PHQ-9 is only nine questions long, but each one was chosen deliberately — they're not random. The nine items map directly onto the nine symptoms the DSM uses to define a major depressive episode, and understanding what each question is actually asking can make your answers more accurate and your score more meaningful.
This is a line-by-line walkthrough of all nine items, plus the extra question you'll often see attached to the end. If you'd rather just take it, our free PHQ-9 test runs about two minutes — but reading this first can help you answer more honestly. (For the scale's history and what your total means, see what is the PHQ-9.)
How the Questions Are Framed
Before the individual items, two things shape every answer:
The time frame is the last two weeks. Every question asks how often a problem has bothered you "over the last 2 weeks." Not your whole life, not your worst-ever stretch — the recent fortnight. This keeps the scale anchored to your current state, and it matches the DSM requirement that depressive symptoms persist for at least two weeks.
Each answer is a frequency, scored 0–3:
- 0 — Not at all
- 1 — Several days
- 2 — More than half the days
- 3 — Nearly every day
You're rating how often, not how intense. A symptom that's mild but constant can score higher than one that's severe but rare. Add up all nine and you get a total from 0 to 27.
Now, the questions themselves.
Question 1: Little interest or pleasure in doing things
This is anhedonia — the clinical name for losing interest or pleasure in things you'd normally enjoy. Food tastes like nothing, hobbies feel like chores, plans you'd once look forward to feel like obligations. It's first for a reason: anhedonia is one of the two cardinal symptoms of major depression, and under DSM criteria at least one of the two must be present for a diagnosis at all.
It's also one of the two questions that make up the PHQ-2 short screener, which tells you how central it is to the whole concept.
Question 2: Feeling down, depressed, or hopeless
The second cardinal symptom: depressed mood. This is the one most people picture when they think of depression — persistent low mood, heaviness, or a sense that things won't get better. The word "hopeless" is doing important work here: hopelessness about the future is a distinct signal, not just a stronger version of sadness.
Notice that Questions 1 and 2 measure different things. You can feel flat and uninterested without feeling sad (numbness is a very real depressive presentation), and you can feel deeply sad while still enjoying moments. That's why both are asked. If you're unsure whether what you feel is depression or an understandable response to hard circumstances, depression vs. sadness draws that line carefully.
Question 3: Trouble falling or staying asleep, or sleeping too much
From here the scale moves into the body. Sleep disturbance in depression runs in both directions — insomnia (lying awake, waking at 3 a.m. and staring at the ceiling) or hypersomnia (sleeping ten hours and still craving more, using sleep to escape the day). Either pattern counts; you score the question the same way. Sleep is often the first symptom to shift when depression is building and one of the first to improve with treatment, which makes this item a sensitive early indicator. (Depression and sleep goes deeper on that two-way relationship.)
Question 4: Feeling tired or having little energy
Fatigue is one of the most common — and most underestimated — depressive symptoms. This isn't ordinary end-of-week tiredness; it's energy that doesn't replenish with rest. Small tasks (showering, replying to a text) feel disproportionately costly. Because fatigue also comes with poor sleep, medical conditions, and plain overwork, this item rarely tells the story alone — but combined with the mood items, it adds real signal.
Question 5: Poor appetite or overeating
Like sleep, appetite in depression is a two-direction symptom: some people lose interest in food entirely, others eat more — often reaching for comfort food to blunt the flatness. Significant weight change in either direction is the underlying DSM criterion. Again, both directions score the same way; the scale cares that your appetite has changed from your normal, not which way it went.
Question 6: Feeling bad about yourself — or that you are a failure or have let yourself or your family down
This is the worthlessness and guilt item, and for many people it's the most painful line on the form. Depression doesn't just lower mood — it distorts self-evaluation. Ordinary setbacks become evidence of personal failure; other people's kindness feels undeserved. The phrase "let yourself or your family down" is there because depressive guilt so often attaches to loved ones. If you find yourself hesitating on this one because "it's just true that I'm failing," that hesitation is itself worth noticing — that's the distortion talking.
Question 7: Trouble concentrating on things, such as reading the newspaper or watching television
The cognitive symptom. Depression measurably impairs concentration and decision-making — pages you re-read without absorbing, shows you can't follow, emails that take an hour to write. The everyday examples in the question are deliberate: it's asking about routine, low-stakes focus, not peak performance. People often blame themselves for this ("I'm just lazy now") when it's a recognized symptom that improves as the depression lifts.
Question 8: Moving or speaking slowly — or being fidgety and restless
This item covers psychomotor changes, and it's unique in one respect: it's the only question phrased around what other people could have noticed. Depression can visibly slow the body — slowed speech, long pauses, moving like you're underwater — or do the opposite, producing agitation, pacing, and an inability to sit still. Both directions count. Because it asks about observable behavior, this item tends to flag more significant depression; mild episodes usually don't move the body in ways others can see.
Question 9: Thoughts that you would be better off dead, or of hurting yourself in some way
The final item asks about suicidal ideation and self-harm, and it deserves to be treated differently from the other eight — so let's be direct and careful.
First, why it's here: thoughts of death and self-harm are a core symptom of major depression, and a depression screener that doesn't ask about them is leaving out the most clinically important question it could ask. Some online versions cut this item (turning the scale into the PHQ-8, a research variant built for telephone surveys). We keep it, because knowing matters.
Second, how to read your answer: the scale's original authors recommend that any answer above "not at all" on this question deserves follow-up — regardless of your total score. A total of 6 with a non-zero Question 9 matters more than the 6 suggests. These thoughts run on a spectrum, from passive ("they'd be better off without me") to active, and any point on that spectrum is worth telling someone about — a doctor, a therapist, someone you trust.
And if that's where you are right now: you don't have to sort this out alone, and you don't need to be in immediate danger to reach out. In the US, call or text 988 (Suicide & Crisis Lifeline) — free, confidential, 24/7. You can also text HOME to 741741 for the Crisis Text Line. If you're outside the US, findahelpline.com lists local services.
The Tenth Question (Not Scored)
Many versions of the PHQ-9 add a final question after the nine:
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
This item is not added to your 0–27 total. It measures functional impairment — how much the symptoms are actually interfering with your life. Two people can have the same score with very different levels of disruption, and clinically that difference matters: symptoms that don't impair functioning are weighed differently from symptoms that do. It's also the question that catches high-functioning depression — real symptoms held behind a functioning exterior at great cost.
Putting It Together
Read as a group, the nine items move in a deliberate arc:
- Items 1–2 — the cardinal core: lost pleasure and low mood. At least one must be present for a diagnosis.
- Items 3–5 — the body: sleep, energy, appetite.
- Items 6–7 — the mind: self-worth and concentration.
- Items 8–9 — the observable and the critical: psychomotor change and thoughts of self-harm.
That structure is why the scale works: it samples depression from several angles instead of asking "are you sad?" nine ways. (Curious how well it actually performs? Is the PHQ-9 accurate? covers the validation research.)
Answering Honestly
A few tips for accurate answers:
- Anchor to frequency, not your worst moment. "Nearly every day" means roughly that — not one terrible afternoon.
- Count both directions. Sleeping too much, overeating, and restlessness count just as much as their opposites.
- Don't grade yourself on output. Getting things done doesn't zero out symptoms. The scale measures how you've felt, not what you've produced.
- Use the full two weeks. Think across the whole period, not just today's mood.
The Bottom Line
The nine PHQ-9 questions each target a distinct, DSM-defined facet of depression — from lost pleasure to sleep and appetite changes to thoughts of self-harm — and the unscored tenth question gauges how much it's all affecting your life. Knowing what each item is really asking helps you answer accurately, which is the whole point of a screening tool. And whatever your total: it's a screen, not a diagnosis — a number to bring to a professional, not a verdict.
Ready to answer them for real? Take our free PHQ-9 test — two minutes, no signup, with your score and a full interpretation at the end.