Summary and structure
The PHQ-4 is an ultra-brief screening tool designed to assess symptoms of depression and anxiety in adults. It was developed by Kroenke, Spitzer, Williams, and Löwe (2009) as a concise combination of two validated two-item measures — the PHQ-2 for depression and the GAD-2 for anxiety. Together, these four items form a rapid, reliable first-line screener for psychological distress.
Each item asks how often the individual has been bothered by specific symptoms over the past two weeks, with response options ranging from “not at all” (0) to “nearly every day” (3). The total score ranges from 0 to 12, reflecting overall psychological distress, while the two subscale scores (PHQ-2 and GAD-2) each range from 0 to 6 and indicate depressive and anxiety symptom burden respectively.
Cut-off scores are interpreted as follows:
0–2 = none to minimal distress
3–5 = mild distress
6–8 = moderate distress
9–12 = severe distress
Key Data
Age group: Adults (≥18 years)
Languages: Available in multiple languages
Intended Use
The intended use of the PHQ-4 is to serve as a brief screening instrument for detecting symptoms of depression and anxiety in general and clinical populations. It is designed for use in primary care, outpatient, and research settings where time constraints make longer questionnaires impractical. The PHQ-4 provides a rapid first indication of psychological distress, allowing healthcare professionals to identify individuals who may benefit from further assessment using more comprehensive tools such as the PHQ-9 or GAD-7, or through a clinical interview. Its brevity makes it well suited for routine screening, large-scale surveys, and digital health platforms, where it can be integrated into regular check-ins to flag emerging mental health concerns and support early intervention.
Information for Practitioners
The PHQ-4 is intended as a first-line screening tool to quickly assess symptoms of depression and anxiety in patients seen in primary care, general medicine, or other non-psychiatric settings. It helps identify individuals who may need further psychological evaluation or support but is not a diagnostic instrument.
A total score of 6 or higher indicates moderate to severe psychological distress and should prompt follow-up assessment. In addition, a score of 3 or more on either subscale (PHQ-2 for depression or GAD-2 for anxiety) suggests the possible presence of a depressive or anxiety disorder. These cut-offs are based on empirical evidence from the original validation studies.
Because the PHQ-4 takes less than one minute to complete, it can easily be integrated into routine check-ups, chronic-disease management, occupational health assessments, or digital platforms. When used digitally, automated scoring and follow-up prompts can support efficient triage and documentation.
Authors
Kurt Kroenke, M.D.
Robert L. Spitzer, M.D.
Janet B.W. Williams, Ph.D.
Bernd Löwe, M.D.
Scientific References
Kroenke K., Spitzer R.L., Williams J.B.W., & Löwe B. (2009). An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics, 50(6), 613–621. https://doi.org/10.1176/appi.psy.50.6.613
Copyright
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