Have you ever filled out a short questionnaire at a doctor’s visit, asking about nervousness, worry, or feeling down over the past two weeks? There’s a good chance it was the GAD-7 or the PHQ-9. These are the two most widely used screening tools for anxiety and depression worldwide, validated in 2001 and 2006 respectively, and they remain the standard in primary care and telehealth intake in 2026.
This guide walks through all 16 questions from both tools, how to answer them, how to score your results, and (most importantly) what to do with that score. One thing deserves attention before you start: one PHQ-9 item asks about thoughts of death or self-harm. If you answer that question with anything other than “Not at all,” there’s a specific safety note further down worth reading carefully.
Key Takeaways
- The GAD-7 (7 items, anxiety) and PHQ-9 (9 items, depression) are validated tools, free to use for clinical and educational purposes
- In the original validation study, the PHQ-9 reached 88% sensitivity and 88% specificity for major depression at a cutoff of ≥10 (Kroenke et al., 2001)
- The GAD-7 reached 89% sensitivity and 82% specificity for generalized anxiety disorder, also at a cutoff of ≥10 (Spitzer et al., 2006)
- Neither questionnaire replaces a clinical evaluation: both are screening tools, not diagnostic instruments
- If the PHQ-9’s self-harm question gets any answer above “Not at all,” seek help now: call or text 988 (Suicide & Crisis Lifeline, US, free, 24/7)
What Are the GAD-7 and PHQ-9?
The GAD-7 (Generalized Anxiety Disorder 7-item scale) and the PHQ-9 (Patient Health Questionnaire-9) are short self-report questionnaires built to flag signs of generalized anxiety and depression in primary care. Neither one requires clinical training to complete. The scoring is simple, which is exactly why they became standard in clinics, hospitals, and telehealth platforms worldwide.
The PHQ-9 was validated by Kroenke, Spitzer, and Williams in 2001, published in the Journal of General Internal Medicine, using data from eight primary care clinics and seven obstetrics clinics (Kroenke et al., 2001). The GAD-7 followed five years later, developed by Spitzer, Kroenke, Williams, and Löwe with more than 2,700 primary care patients, published in Archives of Internal Medicine in 2006 (Spitzer et al., 2006). Both belong to the instrument family developed under the PRIME-MD project and are free to use for clinical, educational, and research purposes without a license.
How to Answer the Questionnaire
The instruction is the same for both scales: think about the past two weeks and pick the option that best describes how often you’ve been bothered by each problem.
| Answer | Points |
|---|---|
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
Answer honestly, without trying to guess the “right” result. The value of the questionnaire comes precisely from capturing what you actually felt, not what you think you should feel.
GAD-7: The 7 Anxiety Screening Questions
Over the last two weeks, how often have you been bothered by the following problems?
- Feeling nervous, anxious, or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it’s hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid, as if something awful might happen
Add up the points from all 7 answers for a total GAD-7 score (0 to 21). The scoring section below explains what the number means.
If restlessness tends to come with chest tightness, what to do about chest tightness from anxiety covers that specific symptom in more depth.
PHQ-9: The 9 Depression Screening Questions
Just like the GAD-7, think back over the last two weeks and rate how often each of the problems below has bothered you.
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself, or that you’re a failure, or have let yourself or your family down
- Trouble concentrating on things, such as reading or watching television
- Moving or speaking so slowly that other people could have noticed, or the opposite: being so fidgety or restless that you’ve been moving around a lot more than usual
- Thoughts that you would be better off dead, or of hurting yourself in some way
Add up the points from all 9 answers for a total PHQ-9 score (0 to 27).
A detail rarely discussed: item 9 of the PHQ-9 doesn’t score suicidal ideation the way a structured clinical interview would. It works as a screening flag: any answer above “Not at all” justifies further evaluation, regardless of the total score from the other 8 items. Someone could score 6 points overall and still need immediate attention if that score is concentrated in item 9. The total sum never replaces reading that one question on its own.
A Note on PHQ-9 Item 9 and Self-Harm Risk
If you answered item 9 (“thoughts that you would be better off dead, or of hurting yourself in some way”) with any option other than “Not at all,” that deserves immediate attention. It’s not something to be ashamed of, and it doesn’t mean something is “wrong” with you.
- Talk to someone you trust about what you’re feeling, right now
- Call or text 988, or chat at 988lifeline.org (Suicide & Crisis Lifeline), free and available 24/7 in the US, or contact your nearest emergency service. Outside the US, search for your country’s crisis line
- If the risk feels immediate, don’t stay alone: ask someone to stay with you or go directly to an emergency room
- After the immediate crisis passes, follow up with a psychologist or psychiatrist for a full evaluation. This item is a signal to act, not just to note
This questionnaire doesn’t assess risk with the depth of a full clinical interview. Its job is to flag that a professional conversation is needed now, not later.
How to Score and Interpret the Result
Score each scale separately. Don’t mix GAD-7 points with PHQ-9 points. The bands below come from the original validation studies and are the same ones used in clinical practice.
GAD-7 (0 to 21 points)
| Score | Anxiety severity |
|---|---|
| 0-4 | Minimal |
| 5-9 | Mild |
| 10-14 | Moderate |
| 15-21 | Severe |
The cutoff of 10 gave the best balance of sensitivity (89%) and specificity (82%) for generalized anxiety disorder in the original sample of over 2,700 patients (Spitzer et al., 2006).
PHQ-9 (0 to 27 points)
| Score | Depression severity |
|---|---|
| 0-4 | Minimal |
| 5-9 | Mild |
| 10-14 | Moderate |
| 15-19 | Moderately severe |
| 20-27 | Severe |
In the validation study, people scoring ≥10 were between 7 and 13.6 times more likely to receive a depression diagnosis in a structured clinical interview, with 88% sensitivity and 88% specificity at that cutoff (Kroenke et al., 2001).
The Result Isn’t a Diagnosis: What to Do Next
A high GAD-7 or PHQ-9 score tells you what you’re feeling, not why. Two people with a score of 15 can have completely different causes behind it: one is living through a generalized anxiety episode, the other is going through recent grief that happens to produce similar symptoms. The questionnaire flags intensity; a clinical interview is what tells the two apart. That’s why a high score is always an invitation to get evaluated, never a diagnosis on its own.
Whatever range you land in, a few practical next steps help:
- Minimal or mild score: keep the result as a reference point and retake the questionnaire if symptoms change. Self-regulation strategies, like the ones covered in 5 evidence-based anxiety strategies, may be enough on their own.
- Moderate score: consider talking to a psychologist. Moderate symptoms that persist for weeks rarely improve on their own.
- Severe score on either scale: seek a professional evaluation as soon as you can. A clinical psychologist handles the initial evaluation; a psychiatrist is the right call if medication needs to be considered.
If the depressive side comes with a sense of lost meaning, it’s worth reading about existential depression. If acute panic episodes are the bigger issue, How to Stop a Panic Attack Fast covers techniques for the moment it happens.
Want to talk through what your result might mean? Book a free 20-minute conversation or learn more about anxiety-focused hypnotherapy.
Frequently Asked Questions
Do the GAD-7 and PHQ-9 give a diagnosis of anxiety or depression?
No. They’re screening tools, built to flag the likelihood and severity of a disorder, not to diagnose one. A diagnosis requires a clinical interview with a psychologist or psychiatrist. Even so, scores ≥10 are strongly associated with a later diagnosis: on the PHQ-9, between 7 and 13.6 times more likely to be confirmed as depression in a clinical interview (Kroenke et al., 2001).
Can I use the GAD-7 and PHQ-9 to track my progress over time?
Yes. That’s one of the most common uses in clinical practice: retaking the questionnaire every 2 to 4 weeks during treatment to see whether the score is trending down. Save your past results and bring them to your appointment. The trend over time usually says more than any single score.
What does a high score on only the GAD-7, but a low PHQ-9 (or vice versa), mean?
It means your symptoms lean toward one specific pattern. Anxiety and depression are distinct conditions, even though some symptoms overlap, like insomnia and irritability. A high GAD-7 alone points to an anxiety-driven pattern; a high PHQ-9 alone points to a mood-driven one. Both scores being high at the same time is also common: anxiety and depression frequently co-occur.
How often should I retake the questionnaire?
There’s no fixed rule outside of clinical follow-up, but every 2 to 4 weeks is a common interval during active treatment. Retaking it daily doesn’t add new information and can increase anxious focus on your own symptoms. If you’re not currently in treatment, once a month is enough to notice trends.
This content is informational and doesn’t replace clinical evaluation, diagnosis, or professional treatment. The GAD-7 and PHQ-9 are screening tools, not diagnostic instruments. If you’re in a crisis or having thoughts of hurting yourself, call or text 988 (Suicide & Crisis Lifeline, US, free, 24/7) or contact your nearest emergency service.
Sources
- Kroenke, K., Spitzer, R.L., Williams, J.B. (2001), “The PHQ-9: validity of a brief depression severity measure”, Journal of General Internal Medicine. Available at: https://onlinelibrary.wiley.com/doi/full/10.1046/j.1525-1497.2001.016009606.x
- Spitzer, R.L., Kroenke, K., Williams, J.B., Löwe, B. (2006), “A brief measure for assessing generalized anxiety disorder: the GAD-7”, Archives of Internal Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/16717171/
- 988 Suicide & Crisis Lifeline (US), free 24/7 emotional support. Available at: https://988lifeline.org/
