The PHQ-9 takes two minutes to administer and gives you a number that correlates surprisingly well with the severity of depressive symptoms. The GAD-7 does the same for generalised anxiety. Both are public- domain, both are validated across populations including South Asian samples, and both are seriously underused in Indian private practice.
When they are used, they’re often used badly. This is a short post on what these tools are for, when they help, and how to integrate them into a real therapy practice without making the work feel like a medical check-up.
What they are
PHQ-9 (Patient Health Questionnaire-9). Nine items, each scored 0–3, total 0–27. Screens for depressive symptoms over the past two weeks. Cut-off scores conventionally: 5+ mild, 10+ moderate, 15+ moderately severe, 20+ severe.
GAD-7 (Generalised Anxiety Disorder-7). Seven items, each scored 0–3, total 0–21. Screens for generalised anxiety over the past two weeks. Cut-offs: 5+ mild, 10+ moderate, 15+ severe.
Both are screening instruments. They are not diagnostic. A PHQ-9 score of 18 doesn’t diagnose major depressive disorder; it tells you a diagnostic interview is warranted.
When they help
Three specific situations:
Intake. Administered at the first session, the PHQ-9 and GAD-7 give you a quick read on the symptom landscape your client is bringing. A 50-minute first session is too short to map symptom severity verbally; the instruments do it in five minutes and free up the rest of the session for context and relationship.
Tracking. Re-administered every four to six weeks, the same instruments give you a course over time. Are symptoms improving with therapy? Plateauing? Worsening? A client whose PHQ-9 drops from 18 to 9 over twelve weeks is showing measurable progress. One whose stays at 18 for three months is showing the same severity, which is a useful clinical fact even if the in-session experience feels productive.
Triage. A score above the moderate threshold, plus item 9 (suicidal ideation) endorsed, plus a clinical impression of crisis — that’s a referral to a psychiatrist, not the next session. Brief screens make this kind of decision more reliable.
The three mistakes that ruin them
Administering them mechanically. A clipboard handed to the client with “fill this out” sets the wrong frame. Better: “I’d like to ask you some specific questions about how you’ve been feeling. It helps me get a clearer picture quickly. We can talk about each item as we go if you want.”
Treating the score as the diagnosis. A PHQ-9 of 14 is not “moderate depression.” It’s an indication that moderate depressive symptoms are present in self-report. The diagnostic work — pattern, duration, functional impairment, ruling out other explanations — still needs the clinical interview.
Skipping item 9. The suicidality item on the PHQ-9. Some therapists pre-fill or skip this because it feels intrusive. Don’t. The information is exactly what brief screens are best at surfacing quickly. If a client endorses item 9, you have a follow-up to do in the session, not later.
How to integrate them into a session
A specific workflow that works.
First session. At about minute 5–10, after the client has begun talking, pause and say: “Before we go further, I’d like to ask you some specific questions about your symptoms — it’ll help me listen better.” Administer PHQ-9 and GAD-7 verbally or on paper. Score during the session. Briefly acknowledge what you noticed (“the items about energy and interest are where you’re scoring highest”). Return to the client’s narrative.
Re-administration. At sessions 6, 12, 24 (roughly monthly). Frame: “I’d like to check in on the symptoms we measured at the start. It helps both of us see how things are moving.” Compare scores out loud with the client. Most clients find this informative; the ones who don’t, don’t have to do it again.
Crisis sessions. If the client’s presentation worsens between scheduled re-administrations, repeat the screens. Faster signal than waiting for the next planned point.
What about other instruments?
The PHQ-9 and GAD-7 are the two most clinically useful brief screens for general practice. Others worth knowing:
- PCL-5. Trauma symptom checklist. Useful when PTSD is in the picture. Twenty items, takes 5–7 minutes.
- AUDIT-C. Three-item alcohol screen. Useful given how under-reported alcohol use is in Indian clinical interviews.
- PSS-10. Perceived Stress Scale. Useful for general distress monitoring outside specific disorders.
- MoCA / MMSE. Cognitive screens. Useful when working with older clients or anyone with suspected cognitive impairment.
For most general adult therapy practice, PHQ-9 and GAD-7 cover the ground. Add others when the presentation calls for them.
What about Indian validation?
A reasonable concern. The PHQ-9 and GAD-7 have been validated in Indian populations, in English and in several Indian languages (Hindi, Tamil, Bengali, Malayalam, Marathi — the coverage varies). The cut-off scores generally translate; some studies suggest minor adjustments for specific Indian samples. The instruments are usable in mainstream practice without modification.
For Indian-language-only clients, ensure you’re using a validated translation rather than your own paraphrase. The differences matter.
Where they live in your records
A practice-management tool should store assessment scores in a way that lets you see them at a glance. Specifically:
- Score per administration, with date.
- Visual trend over time if possible (a small chart helps the client too).
- Notes attached per administration (any items the client elaborated on).
- Easy comparison between dates.
Most tools handle this poorly. Ours has basic assessment storage with the PHQ-9 and GAD-7 built in; we’re working on more visualisation.
A close
Brief screens are not a substitute for clinical judgement. They are a reliable supplement to it. Used well, they let you start sessions with information that would otherwise take three or four hours of verbal exploration to gather. Used badly, they turn the relationship into a medical encounter.
The skill is in the framing. The instrument is a starting point for conversation, not a verdict. When you frame it that way, most clients find the screens useful and even reassuring — there’s a structure to the work, and progress can be seen.
For the everyday recordkeeping, our practice-management tool is at mindmaster.modoware.com. For the instruments themselves, both PHQ-9 and GAD-7 are public-domain; PDFs are easy to find via the NHS, MDCalc, and the original Spitzer and Williams papers.