PHQ-9 and GAD-7: Depression and Anxiety Screening
Both screeners together, with the item 9 self-harm question flagged on its own · v1.01. PHQ-9: Depression, Over the Last 2 Weeks
Over the last 2 weeks, how often have you been bothered by any of the following problems?
2. GAD-7: Anxiety, Over the Last 2 Weeks
Over the last 2 weeks, how often have you been bothered by the following problems?
Clinical Application & Nuances
1. Question 9 Is Screened On Its Own, Not Only In The Total
A patient can score low overall and still endorse question 9. The total score is not a safety net for that one item. Any answer other than "Not at all" on question 9 warrants a direct, structured follow-up conversation about suicidal ideation and plan, in the same visit, whatever the rest of the questionnaire shows.
2. What The PHQ-9 Bands Suggest
| Score | Severity | Suggested action |
|---|---|---|
| 0-4 | None-minimal | None indicated on this score alone |
| 5-9 | Mild | Watchful waiting, repeat at follow-up |
| 10-14 | Moderate | Treatment plan: counselling, follow-up, or pharmacotherapy |
| 15-19 | Moderately severe | Active pharmacotherapy and/or psychotherapy |
| 20-27 | Severe | Immediate pharmacotherapy; expedited specialist referral if response is poor or impairment is severe |
This action column is the interpretation guide published alongside the instrument itself, not a finding independent of it. Individual judgement, the functional impairment answer, and the patient in front of you still decide the actual plan.
3. What The GAD-7 Bands Suggest
A score of 10 or more is the threshold the original validation study reported as reasonably sensitive and specific for generalised anxiety disorder, and is the point at which further evaluation is generally warranted. Below that, a score of 5 to 9 still identifies mild symptoms worth monitoring, and a score of 15 or more suggests severe anxiety that usually needs active treatment.
4. They Are Usually Run Together, Because The Conditions Usually Are
Depression and anxiety are frequently comorbid, and a patient who screens positive on one is more likely to screen positive on the other. Running both at once, as this tool does, catches the combination rather than whichever condition happened to prompt the visit.
5. What Indian Validation Has Found
A psychometric analysis in a rural Kerala cohort found the factor structure of both the PHQ-9 and the GAD-7 comparable to the Western validation samples, supporting their use as screening instruments in an Indian primary care population. It did not propose an India-specific cutoff, and cautioned against splitting either instrument into subscales. Separate work adapting the PHQ-9 into Hindi for palliative care patients found acceptable internal consistency and a two-factor structure, again without establishing a different diagnostic threshold. The original bands above are what these studies have used, not what they have replaced.
6. Hindi and Kannada Versions Exist, But Are Not Reproduced Here
Validated or officially translated Hindi and Kannada versions of these instruments exist, distributed through the same free-use terms as the English original. They are not reproduced in this tool because the item wording has not been independently sourced and checked here, and an invented or imprecisely remembered translation is worse than no translation. A Hindi or Kannada version should be added only once the actual licensed text has been obtained and checked against a primary source, not written from memory.
7. This Tool Does Not Replace A Risk Assessment
A positive answer on question 9 needs a direct conversation, not a calculator: ask about current thoughts, intent, plan and access to means, and involve psychiatry the same day where risk seems current. The national Tele-MANAS service, 14416 or 1-800-891-4416, is available 24 hours, in multiple languages, for the patient to call directly or to be connected to during the consultation.
Algorithm References & Evidence Base
- Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
- Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.
- Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509-515.
- Löwe B, Decker O, Müller S, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266-274.
- Pfizer Inc. Instructions for Patient Health Questionnaire (PHQ) and GAD-7 Measures. Developed by Spitzer RL, Williams JBW, Kroenke K, and colleagues; no permission required to reproduce, translate, display or distribute.
- De Man J, Absetz P, Sathish T, et al. Are the PHQ-9 and GAD-7 suitable for use in India? A psychometric analysis. Front Psychol. 2021;12:676398.
- Bhardwaj T, Arora N, Rajvanshi A. Psychometric evaluation of Patient Health Questionnaire 9 Hindi for use with patients with cancer in community palliative care settings. Indian J Palliat Care. 2025;31(2):177-185.
- Ministry of Health and Family Welfare, Government of India. Tele-MANAS: National Tele Mental Health Programme. NIMHANS, coordinating institute. telemanas.mohfw.gov.in.
How to Cite This Tool
AMA Style:
Umakanth S. PHQ-9 + GAD-7 Depression and Anxiety Screening. MEDiscuss. Published 2026. Accessed .
Vancouver Style:
Umakanth S. PHQ-9 + GAD-7 Depression and Anxiety Screening [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:
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