1PHQ-9 Score Interpretation & Stepped Care
| Score | Severity Tier | Clinical Action & Stepped-Care Plan |
|---|---|---|
| 0–4 | Minimal | No formal intervention required. Provide general wellness guidance and sleep hygiene advice. |
| 5–9 | Mild | Watchful waiting and psychoeducation. Guided self-help CBT and exercise. Re-evaluate in 4 weeks. |
| 10–14 | Moderate | Validated clinical cutoff (≥10). Formulate active treatment plan: structured CBT, consider SSRI pharmacotherapy. Review in 2 weeks. |
| 15–19 | Moderately Severe | Active treatment indicated: initiate first-line SSRI medication and refer for high-intensity psychological therapy. Regular safety monitoring. |
| 20–27 | Severe | Immediate pharmacotherapy initiation. Urgent psychiatric referral. Comprehensive suicide safety assessment and consider crisis team involvement. |
2PHQ-9 Item 9 — Mandatory Suicide Risk Assessment
🚨 Clinical Safety Directive: Question 9 screens for thoughts of death and self-harm. Any endorsement (≥1 point) mandates a direct clinical suicide risk assessment, regardless of whether the total composite score is low or high. Clinicians must directly evaluate:
- Active vs. passive suicidal ideation.
- Presence of a specific plan, timeline, and intent to act.
- Access to lethal means (medications, firearms, heights).
- Past history of self-harm or suicide attempts.
- Protective factors, social support, and formulation of an emergency safety plan.
3GAD-7 Score Interpretation
| Score | Severity Tier | Clinical Action Plan |
|---|---|---|
| 0–4 | Minimal Anxiety | Reassurance; lifestyle optimization; stress-reduction techniques. |
| 5–9 | Mild Anxiety | Psychoeducation, sleep hygiene, mindfulness, and guided self-help. Review in 4–6 weeks. |
| 10–14 | Moderate Anxiety | Clinical cutoff (≥10). Refer for structured Cognitive Behavioral Therapy (CBT). Consider SSRI initiation. Rule out somatic causes (thyroid dysfunction, arrhythmias, caffeine excess). |
| 15–21 | Severe Anxiety | Combined SSRI pharmacotherapy and intensive CBT. Psychiatric consultation if panic attacks or severe functional disability are present. |
4First-Line Evidence-Based Treatments
Pharmacotherapy (SSRIs First-Line)
- Escitalopram: 10 mg once daily (high selectivity, favorable tolerability).
- Sertraline: 50 mg once daily (safest profile in cardiovascular disease and elderly).
- Fluoxetine: 20 mg once daily (long half-life, low discontinuation syndrome risk).
- Duration: Allow 4–6 weeks for therapeutic response. Continue for a minimum of 6–12 months after remission to prevent relapse.
Psychological Interventions
- Cognitive Behavioral Therapy (CBT): 8–16 structured individual sessions. First-line for depression and GAD; superior to pharmacotherapy in preventing long-term relapse.
- Mindfulness-Based Cognitive Therapy (MBCT): Recommended for recurrent depressive episodes (≥3 lifetime episodes).
- Combined Approach: For moderate-to-severe presentations, combined SSRI + CBT yields superior recovery rates over monotherapy.
5Frequently Asked Questions
Clinical Disclaimer: The PHQ-9 and GAD-7 are validated screening instruments, not standalone diagnostic tools. High scores indicate the necessity for a comprehensive diagnostic psychiatric interview. Medical organic causes (such as hypothyroidism, anemia, and B12 deficiency) must be excluded before attributing somatic complaints solely to primary affective disorders.