Severity Rating
What a severity rating is, the severity ranges of common measures such as the PHQ-9 and GAD-7, and how to chart severity in a progress note.
Quick Answer
A severity rating records how intense, frequent or impairing a person’s symptoms are, so change can be tracked over time. It can come from a standardized measure (for example, a PHQ-9 score of 14 falls in the moderate range for depression), a clinician rating such as a DSM-5-TR severity specifier (mild, moderate or severe), or the person’s own rating, such as “anxiety 7 out of 10.” Record the source, the score and possible range, the severity band and how it fits with what you observed and the person’s functioning. A score on its own is not a diagnosis.
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Definition
A severity rating puts a number or a defined level on how much symptoms are affecting a person at a point in time. Repeating the same rating at regular intervals shows whether treatment is helping, which is the idea behind measurement-based care.
There are three common sources. Self-report measures, such as the PHQ-9 for depression or the GAD-7 for anxiety, are completed by the client and scored into bands. Clinician ratings include DSM-5-TR severity specifiers, which many diagnoses carry, and global scales such as the Clinical Global Impression-Severity (CGI-S). Subjective ratings, such as a 0 to 10 scale or Subjective Units of Distress (SUDS) in exposure work, are quick and useful for tracking within and between sessions but are not standardized.
Common severity measures and their ranges
Use the current version of each measure and its published scoring instructions. Screening cut-offs suggest a possible problem; diagnosis needs a clinical assessment.
| Measure | What it rates | Score range | Severity bands or common use |
|---|---|---|---|
| PHQ-9 | Depression symptoms over the past 2 weeks | 0 to 27 | 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. Item 9 asks about thoughts of death or self-harm; any score above 0 needs a direct suicide risk assessment in the same session. |
| GAD-7 | Anxiety symptoms over the past 2 weeks | 0 to 21 | 0-4 minimal, 5-9 mild, 10-14 moderate, 15-21 severe. |
| PCL-5 | PTSD symptoms over the past month | 0 to 80 | No fixed severity bands. A score of 31 to 33 is often used to suggest probable PTSD; the National Center for PTSD suggests a 10-point decrease as an indicator of treatment response. |
| AUDIT | Alcohol use over the past year | 0 to 40 | WHO risk zones: 0-7 lower risk, 8-15 increasing risk, 16-19 higher risk, 20 or more possible dependence, which needs further assessment. |
| CGI-S | Clinician’s overall rating of illness severity | 1 to 7 | 1 normal, not at all ill, to 7 among the most extremely ill patients. |
| DSM-5-TR specifiers | Clinician’s severity rating for a diagnosis | Mild, moderate or severe | Criteria vary by diagnosis. For example, substance use disorder is mild with 2-3 criteria, moderate with 4-5 and severe with 6 or more. |
How to chart a severity rating in a progress note
Give the measure, the score with its range, the band, the comparison with the last score, and whether it fits what you observed and what the client reports about daily functioning. Follow up any risk item in the same session.
Weak documentation: “Symptoms severe.”
Stronger documentation: “PHQ-9 = 12 (moderate range, 0-27), down from 17 (moderately severe) at intake; item 9 = 0. Consistent with client’s report of returning to work part time.”
Severity ratings in a SOAP note
Client-reported ratings go in Subjective and scored measures usually go in Objective. A short fictional example from a follow-up session for depression and anxiety:
Subjective: Fictional adult client, session 7. Rates anxiety 6 out of 10 this week, down from 8 out of 10 at intake. Returned to work 3 days a week; still finds it hard to concentrate in meetings.
Objective: PHQ-9 = 12 (moderate range, 0-27), down from 17 (moderately severe) at intake 6 weeks ago. Item 9 scored 0; on direct questioning, denied thoughts of death, suicide or self-harm. GAD-7 = 11 (moderate range, 0-21), down from 15 (severe). Affect mildly restricted, brighter than at intake.
Assessment: Depression and anxiety symptoms reduced since intake on both measures, consistent with her return to part-time work; both remain in the moderate range and continue to affect concentration at work.
Plan: Continue weekly CBT with a focus on worry-scheduling and concentration strategies. Repeat PHQ-9 and GAD-7 every 2 weeks. Client knows to call or text 988 if thoughts of suicide arise, or to call 911 in an emergency.
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Tips for documenting severity ratings
Name the source: Write which measure or scale you used, and whether the rating came from the client, the clinician or another informant.
Give the range and band: “PHQ-9 = 12” means more to the reader as “PHQ-9 = 12 (moderate range, 0-27).”
Compare like with like: Use the same measure at regular intervals and compare with the baseline and the last score.
Check against functioning: Say whether the score fits what you observed and what the client reports about work, relationships and daily life. Explain any mismatch.
Act on risk items: Any positive answer on a risk item, such as PHQ-9 item 9, needs a direct risk assessment in the same session and documentation of what you did.
Keep the score in context: Literacy, language, culture and the client’s understanding of the questions affect scores. A score supports clinical judgment; it does not replace it.
Common mistakes to avoid
- A band with no score or source: “severe” on its own does not show how you decided
- Treating a screening score as a diagnosis: a positive screen needs a clinical assessment
- Ignoring item 9: a total score can look mild while the risk item is positive
- Switching measures without saying so: scores from different measures are not directly comparable
- Copying old scores forward: record the date the measure was completed
Frequently asked questions
What is a severity rating in mental health documentation?
A severity rating records how intense, frequent or impairing a person’s symptoms are at a point in time. It can come from a standardized measure such as the PHQ-9, a clinician rating such as a DSM-5-TR severity specifier, or the client’s own rating on a 0 to 10 scale. Repeating it shows whether treatment is helping.
What are the PHQ-9 severity ranges?
PHQ-9 scores range from 0 to 27: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe and 20-27 severe. Item 9 asks about thoughts of death or self-harm, and any score above 0 on that item needs a direct suicide risk assessment in the same session, whatever the total.
What are the GAD-7 severity ranges?
GAD-7 scores range from 0 to 21: 0-4 minimal, 5-9 mild, 10-14 moderate and 15-21 severe. Like other screening measures, it suggests how severe anxiety symptoms are but does not diagnose a specific anxiety disorder.
How do you document a severity rating in a progress note?
Give the measure, score and possible range, the severity band and the comparison with the last score, and say whether it fits the client’s functioning. For example: “PHQ-9 = 12 (moderate range, 0-27), down from 17 at intake; item 9 = 0; consistent with return to part-time work.”
Is a severity score the same as a diagnosis?
No. A score shows how severe symptoms are on that measure, and screening cut-offs suggest a possible problem. A diagnosis rests on a clinical assessment of the full history, symptoms, duration, impairment and other possible explanations.
Related guides: screening measures in progress notes · screening tools · outcome measures · functional impairment · baseline assessment.
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Further Reading
- DSM-5-TR — The American Psychiatric Association’s diagnostic manual, which includes severity specifiers for many diagnoses.
- NIMH (National Institute of Mental Health) — Plain-language information on mental health conditions, their symptoms and current research.
- Screening measures in progress notes — How to record PHQ-9, GAD-7 and other measures in session notes.