The PHQ-9 is used by GPs and IMH across Singapore to screen for depression — but most people don't know it exists. Here is how to interpret your score and what to do with it.
If you have ever visited a GP in Singapore about persistent low mood, fatigue, or sleep difficulties, there is a reasonable chance you were asked to fill in a brief questionnaire. Nine questions. Takes about two minutes. Rates how often over the past two weeks you've been bothered by specific symptoms.
That was the PHQ-9. And it is one of the most validated, widely used, and least understood tools in mental health.
The Patient Health Questionnaire-9 was developed by Drs Robert Spitzer, Janet Williams, and Kurt Kroenke as a practical screening tool for depression in primary care settings. It was published in 2001 and has since been validated in over 8,000 published studies across dozens of countries and languages.
It maps directly onto the DSM-5 criteria for Major Depressive Disorder — the nine symptoms that clinicians use to diagnose depression. Each item asks about frequency over the past two weeks, rated 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27.
The PHQ-9 is used in General Practitioner clinics across Singapore as a first-line screening tool when patients present with potential depression symptoms. The Institute of Mental Health (IMH) uses it in assessment settings. It is part of many corporate health screening programmes. And it forms part of Heal Counselling's free Clarity Check.
Despite this, very few people who have filled it in know what their score means or what to do with it.
**0–4 (Minimal):** Below clinical threshold. If you score here, monitoring is appropriate — a persistent pattern in this range with no other concerns is a positive sign.
**5–9 (Mild):** Mild depressive symptoms. At this level, a watch-and-wait approach is sometimes recommended, along with lifestyle factors: sleep, exercise, social connection. If you score here consistently over multiple weeks, or if the symptoms are significantly affecting daily function, professional input is worthwhile.
**10–14 (Moderate):** The clinical literature consistently supports treatment at this level. Evidence-based therapy — particularly CBT and behavioural activation — shows very good outcomes for moderate depression. If you score here, a conversation with a mental health professional is recommended.
**15–19 (Moderately Severe):** At this level, a combination of therapy and medication is often most effective. A referral to a psychiatrist for a medication assessment, alongside therapy, is worth considering. Your GP can facilitate this.
**20–27 (Severe):** Scores at the severe end indicate significant clinical depression. Prompt engagement with a mental health professional is important. If you scored here, please contact Heal Counselling, your GP, or the IMH helpline (6389 2222).
A significant limitation of the PHQ-9 in Singapore's cultural context is underreporting. Research comparing PHQ-9 scores with structured clinical interviews in multicultural Asian populations consistently finds that PHQ-9 scores underestimate prevalence — particularly among populations where emotional expression is more reserved and where stigma around mental health remains significant.
The item "I've been feeling bad about myself" — one of the PHQ-9's core items — may be answered conservatively by people who view the question through a lens of cultural humility rather than clinical depression. Similarly, items about fatigue may be attributed to work demands rather than depressive symptoms.
This matters clinically: a PHQ-9 score in the mild range (5–9) may represent moderate depression in contexts where underreporting is likely. A skilled clinician will interpret the score alongside everything else they observe.
First: treat it as information, not a verdict. A number between 0 and 27 does not define you. It is a snapshot, taken at a specific moment, using a specific tool.
Second: use it as language. Many people struggle to explain how they're feeling — to themselves, to a GP, to a therapist. A PHQ-9 score gives you a starting framework. You can say "I scored 13 on the PHQ-9" and a clinician can immediately orient to the territory.
Third: if your score is 10 or above, act on it. Not because a number demands a response, but because scores in that range indicate that depression is affecting your functioning — and depression is very treatable, particularly when addressed earlier rather than later.
The Clarity Check at Heal Counselling includes the PHQ-9 as one of three validated screening tools, alongside the GAD-7 (anxiety) and WHO-5 (wellbeing). Taking 5 minutes to complete it gives you a clinical baseline — and a personalised report delivered to your inbox immediately. If you score 10 or above, a free 30-minute consultation with Nidhi is a natural next step.
The free Clarity Check takes 5 minutes and gives you a personalised report with clinical screening results.
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