Outcome Questionnaire 45

Scoring

Each item is scored 0 (Never) to 4 (Almost Always). After reverse-coding certain items, subscale totals are computed by addition. The Symptom Distress subscale (25 items) ranges from 0 to 100, Interpersonal Relations (11 items) from 0 to 44, and Social Role (9 items) from 0 to 36.

The total score (0–180) is the sum of the three subscales. Higher scores indicate greater distress and impairment. The manual provides thresholds for clinically significant distress and for reliable change.

Use in research

The OQ-45 has been employed in research on enhancing psychotherapy and counseling outcomes, evaluating therapist effectiveness over time, and assessing mental health agency performance. A 2025 study of 456 clients in 5,917 low-fee online counseling sessions at the Sentio Counseling Center found that sessions where the therapist reviewed the client’s OQ score beforehand showed significantly larger symptom improvement by the next session than sessions without such review. Therapists who reviewed scores more frequently before sessions achieved faster client symptom recovery across all clients.

Did You Know?

• The instrument is not intended for diagnostic purposes.
• It was designed to be low cost, quick to administer, and sensitive to change over time.
• Originally a paper version, it later became available in mobile and web-based formats.