What your PHQ-9 and GAD-7 scores mean: depression and anxiety screening, explained

More and more clinics in India hand a new patient a short questionnaire before the doctor sees them. Nine questions about the last two weeks, each answered on a scale from “not at all” to “nearly every day”, and a number at the end. Some people get it on paper at the front desk; some get a link on their phone; some see it in a general practitioner’s room when they came in about something else, such as sleep or a stomach that will not settle.

That questionnaire is usually the PHQ-9, often with a shorter cousin, the GAD-7, under it. Both are free, both take under five minutes, and both are used by clinics all over the world. The score is useful. It is also widely misread, by patients who treat it as a diagnosis and by a few clinics that do the same. This article explains what the numbers mean, what they do not mean, and what a sensible next step looks like at each level. It does not replace a consultation with your own doctor.

What a screener is for

A screening questionnaire answers one question: is this worth a closer look? It does not answer the question that matters, which is what is going on and what to do about it. A blood pressure reading in a pharmacy works the same way. A high number means “see a doctor”, not “you have hypertension”, and a normal number on one day does not rule anything out.

Screeners for mood and anxiety exist because these conditions are common, treatable, and often missed. In India, the National Mental Health Survey of 2015 to 2016 found that roughly one adult in ten had a mental health condition needing care, and that most of them were getting none. A patient who comes in about headaches or poor sleep will not usually say “I think I am depressed.” A questionnaire gives both sides a way to raise it.

The PHQ-9: nine questions about the last two weeks

PHQ stands for Patient Health Questionnaire. The nine items follow the nine features doctors use to diagnose a depressive episode: low mood, loss of interest, sleep, energy, appetite, feeling bad about yourself, trouble concentrating, being slowed down or restless, and thoughts of death or self-harm. Each is scored 0 (not at all), 1 (several days), 2 (more than half the days) or 3 (nearly every day), for a total out of 27.

The usual bands are:

Total	Reading
0 to 4	Minimal or none
5 to 9	Mild
10 to 14	Moderate
15 to 19	Moderately severe
20 to 27	Severe

Three things about these numbers are worth knowing.

Ten is the working cut-off. In the studies that validated the questionnaire, a score of 10 or more caught most people who had major depression when properly assessed, while missing a few and flagging some who did not. So 10 is where clinics start a proper conversation, not where a diagnosis begins.

The last question is read on its own. Question 9 asks how often you have had “thoughts that you would be better off dead, or of hurting yourself in some way”. Any answer other than 0 is taken seriously whatever the total. A total of 6 with a 2 on question 9 matters more than a total of 12 with a 0 there. If this is you, the next section of this article is about what to do.

The tenth question is not scored. Many versions end with “how difficult have these problems made it to do your work, take care of things at home or get along with other people?” That answer is not part of the total. It tells the doctor how much the symptoms are costing you, which often matters more than the number.

The GAD-7: seven questions about worry

GAD stands for Generalised Anxiety Disorder, and the seven items ask about feeling nervous, not being able to stop worrying, worrying about too many things, trouble relaxing, restlessness, irritability and a sense that something awful might happen. Same answer scale, total out of 21.

Total	Reading
0 to 4	Minimal
5 to 9	Mild
10 to 14	Moderate
15 to 21	Severe

The GAD-7 was built for one kind of anxiety but turns out to pick up others too: panic attacks, social anxiety and the aftermath of a frightening event all push the score up. That is why a high GAD-7 leads to a conversation about what the worry is like and when it started, rather than straight to a label.

The WHO-5: the one where high is good

Some clinics, and the 92health app, also offer the WHO-5 Well-Being Index. It asks five positive questions about the last two weeks: whether you have felt cheerful, calm, active, rested, and interested in your days. Each is scored 0 to 5, the total is multiplied by four to give a figure out of 100, and here a higher number is better. A score of 50 or under is read as poor wellbeing and worth a closer look; 28 or under is the level at which depression becomes likely. If you have taken the PHQ-9 and the WHO-5 on the same day, do not be confused that one went up while the other went down. They point in opposite directions by design.

What a score is not

A score is not a diagnosis. Depression and anxiety are diagnosed by a clinician who takes a history, asks how long this has been going on and what else is happening in your life, examines you, and rules out other causes. Several physical conditions produce the same answers on a PHQ-9: an underactive thyroid, anaemia, vitamin B12 deficiency, uncontrolled diabetes, sleep apnoea, and the side effects of some medicines, including a few blood pressure tablets and steroids. Heavy drinking does too. That is why a first visit to a psychiatrist or physician often includes a few blood tests. The questionnaire cannot tell these apart; the doctor can.

A score is not a grade. A 7 does not mean “slightly broken”. The bands are convenient labels for ranges that overlap a great deal in real people, and two patients with the same total can need very different things.

A score on one day is not a trend. People score higher after a bad night, a bad week at work or a bereavement. This is exactly why the questionnaire asks about two weeks and why repeating it after some time tells you more than any single number.

If you ticked anything on question 9

Thoughts of being better off dead, or of hurting yourself, are more common than people admit, and most people who have them do not act on them. They are still a reason to talk to someone soon, not next month.

• If you have a plan, have taken something, or have hurt yourself, call 112 or 108, or go to the nearest emergency room now.
• If the thoughts are there but you are safe for now, call Tele-MANAS on 14416. It is the Government of India’s mental health helpline: free, open 24 hours, and answered in more than twenty Indian languages by trained counsellors who can also connect you to a psychiatrist. The toll-free number 1800-891-4416 reaches the same service.
• Tell one person you trust. The point is not for them to fix it; it is so that you are not carrying it alone until you see a professional.
• Make your surroundings a little safer: give medicines you do not need to someone else to keep for a while, and avoid alcohol, which lowers the brakes.

In India, attempting suicide is no longer a crime. The Mental Healthcare Act of 2017 says a person who attempts it is presumed to be under severe stress and is to be given care, not prosecuted. You can go to a hospital and say what happened.

What to do at each level

Minimal (PHQ-9 of 0 to 4, GAD-7 of 0 to 4). Nothing is needed because of the score. If you took it because something feels wrong, trust that over the number and talk to a doctor anyway. Screeners miss people, especially those who have been low for so long that it feels normal.

Mild (5 to 9). Many people in this band get better without treatment over a few weeks, and the things that help are ordinary: a regular sleep time, daily movement, less alcohol, time with people, and fewer hours alone with a phone. Take the questionnaire again in two to four weeks. If the score has not moved, or the tenth question says it is getting in the way of work or home, see a doctor.

Moderate and above (10 and higher). See a doctor. A general physician is a fine first stop and can rule out the physical causes above; a psychiatrist or clinical psychologist is the next step if treatment is needed. Both talking therapies and medicines work for moderate depression and anxiety, and for many people the combination works best. Which to choose depends on your preference, what is available near you and what the assessment finds. Our guide to who does what in mental health care in India, linked below, explains the difference between a psychiatrist, a psychologist and a counsellor and what a first visit involves.

Severe (20 and higher on the PHQ-9, 15 and higher on the GAD-7). See a doctor this week, and do not wait to see whether it passes. At this level people often cannot do the ordinary things that help, and treatment is what makes them possible again.

How clinics use the score over time

Once treatment starts, the questionnaire becomes a measuring tape. Clinics repeat it at follow-up visits, usually every two to four weeks at first. Two words you may hear:

• Response means the score has fallen by half or more from where it started.
• Remission means a PHQ-9 under 5 (or a GAD-7 under 5): symptoms have largely gone.

If your score has not fallen by much after six to eight weeks of a treatment taken as prescribed, that is useful information, not a failure. It is the point at which a doctor would normally change the dose, add something or try a different approach. Keep your scores, or ask the clinic for them, so that the next doctor you see does not have to start from nothing.

Which questionnaire is for whom

The PHQ-9 and GAD-7 were validated in adults. Children and teenagers, older people and women around childbirth are usually screened with versions written for them:

• PHQ-A for adolescents aged 12 to 17, which asks about the same nine features in words a teenager recognises.
• GDS-15 (the Geriatric Depression Scale) for older adults, which asks yes or no questions and leaves out the physical symptoms that come with age anyway.
• EPDS (the Edinburgh Postnatal Depression Scale) in pregnancy and after a birth.

If a clinic gives a sixty-five-year-old a PHQ-9, the score still means something, but it is not the best tool, and a doctor will weight it accordingly.

Taking the screener in your own language

The questionnaires were written in English and have been translated and tested in most Indian languages. A translation matters more than it sounds: “feeling down, depressed or hopeless” is not one idea in every language, and a bad translation changes what is being asked. If a clinic offers the questionnaire in Tamil, Hindi, Telugu, Malayalam or Kannada, take it in the language you think in. The score means the same thing.

Your score belongs to you

A screening score is health information about you. A clinic that records it should be able to show it to you, print it on your visit summary and compare it with the last one. In the 92health app you can take the PHQ-9, GAD-7 and WHO-5 yourself, see the result with a plain-language reading of what it means, keep each score beside the earlier ones, and share them with a clinic when you choose to. A clinic that uses 92health sees the scores you have shared on the same screen as its own, so you are not asked the same nine questions at every visit.

If anything in this article has described you, the number is the least important part. The conversation it starts is the point.