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Patient Health Questionnaire-2 (PHQ-2)

2-item depression screening tool derived from the first two questions of the PHQ-9

CreatorDr. Robert Spitzer, MD
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Questions

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Introduction

The PHQ-2 (Patient Health Questionnaire-2) is a two-question survey that screens for depression. Kurt Kroenke, MD, Robert L. Spitzer, MD, and Janet B.W. Williams, DSW, developed it in 2003 from the first two items of the PHQ-9. It asks about the two core symptoms of depression: low mood and loss of interest or pleasure. Because it takes less than a minute, it’s widely used in primary care and other busy settings. Its purpose is not to establish a final diagnosis or to monitor depression severity, but to screen for depression.

What it asks: Patients rate how often, over the past two weeks, they have been bothered by two problems: little interest or pleasure in doing things, and feeling down, depressed, or hopeless. Each item uses the same four answers: 0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day.

How it’s scored: The two item scores are added together for a total from 0 to 6. Higher scores mean more frequent depressive symptoms. The developers identified a score of 3 as the best cutoff for screening, and noted that a cutoff of 2 would catch more cases, while a cutoff of 4 would produce fewer false positives. In the original study, a score of 3 or higher had a sensitivity of 83% and a specificity of 92% for major depression.

Operating Characteristics of PHQ-2 as a Screener for Depressive Disorders in 580 Patients Who Had an Independent Mental Health Professional Interview

Major Depressive Disorder (7% Prevalence)

PHQ-2 Score

Sensitivity

Specificity

Positive Predictive Value (PPV*)

1

97.6

59.2

15.4

2

92.7

73.7

21.1

3

82.9

90.0

38.4

4

73.2

93.3

45.4

5

53.7

96.8

56.4

6

26.8

99.4

78.6

Any Depressive Disorder (18% Prevalence)

PHQ-2 Score

Sensitivity

Specificity

Positive Predictive Value (PPV*)

1

90.6

65.4

36.9

2

82.1

80.4

48.3

3

62.3

95.4

75.0

4

50.9

97.9

81.2

5

31.1

98.7

84.6

6

12.3

99.8

92.9

*Because the PPV varies with the prevalence of depression, the PPV will be higher in settings with a higher prevalence of depression and lower in settings with a lower prevalence.

How results are used: A score of 3 or higher is a positive screen. Patients who screen positive should be further evaluated with the PHQ-9 to determine whether they meet criteria for a depressive disorder. A score below 3 is a negative screen, but it doesn’t rule out depression if other concerns are present. The PHQ-2 also has no question about suicide or self-harm, so it can’t be used to assess safety. When there’s concern, follow up with the PHQ-9 or a clinical assessment.

All questions & possible results

Questions

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Feeling down, depressed, or hopeless

Select one option:

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
Possible results
PHQ-2 total score 4: Positive Screen. Depression likely.

Patients who screen positive should be further evaluated with the PHQ-9, other diagnostic instruments, or direct interview to determine whether they meet criteria for a depressive disorder.

Statistical Measures for Major Depressive Disorder (7% Prevalence)

  • Sensitivity 73.2%

  • Specificity 93.3%

  • Positive Predictive Value* 45.4%

Statistical Measures for any Depressive Disorder (18% Prevalence)

  • Sensitivity 50.9%

  • Specificity 97.9%

  • Positive Predictive Value* 81.2%

Notes:

*Because the PPV varies with the prevalence of depression, the PPV will be higher in settings with a higher prevalence of depression and lower in settings with a lower prevalence.

Source: Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

PHQ-2 total score 3: Positive Screen. Depression likely.

Patients who screen positive should be further evaluated with the PHQ-9, other diagnostic instruments, or direct interview to determine whether they meet criteria for a depressive disorder.

Statistical Measures for Major Depressive Disorder (7% Prevalence)

  • Sensitivity 82.9%

  • Specificity 90%

  • Positive Predictive Value* 38.4%

Statistical Measures for any Depressive Disorder (18% Prevalence)

  • Sensitivity 62.3%

  • Specificity 95.4%

  • Positive Predictive Value* 38.4%

Notes:

*Because the PPV varies with the prevalence of depression, the PPV will be higher in settings with a higher prevalence of depression and lower in settings with a lower prevalence.

Source: Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

PHQ-2 total score 5: Positive Screen. Depression likely.

Patients who screen positive should be further evaluated with the PHQ-9, other diagnostic instruments, or direct interview to determine whether they meet criteria for a depressive disorder.

Statistical Measures for Major Depressive Disorder (7% Prevalence)

  • Sensitivity 53.7%

  • Specificity 96.8%

  • Positive Predictive Value* 56.4%

Statistical Measures for any Depressive Disorder (18% Prevalence)

  • Sensitivity 31.1%

  • Specificity 98.7%

  • Positive Predictive Value* 84.6%

Notes:

*Because the PPV varies with the prevalence of depression, the PPV will be higher in settings with a higher prevalence of depression and lower in settings with a lower prevalence.

Source: Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

PHQ-2 total score 6: Positive Screen. Depression likely.

Patients who screen positive should be further evaluated with the PHQ-9, other diagnostic instruments, or direct interview to determine whether they meet criteria for a depressive disorder.

Statistical Measures for Major Depressive Disorder (7% Prevalence)

  • Sensitivity 26.8%

  • Specificity 99.4%

  • Positive Predictive Value* 78.6%

Statistical Measures for any Depressive Disorder (18% Prevalence)

  • Sensitivity 12.3%

  • Specificity 99.8%

  • Positive Predictive Value* 92.9%

Notes:

*Because the PPV varies with the prevalence of depression, the PPV will be higher in settings with a higher prevalence of depression and lower in settings with a lower prevalence.

Source: Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

PHQ-2 total score 1: Negative Screen. Depression unlikely.

The PHQ-2 also has no question about suicide or self-harm, so it can’t be used to assess safety. When there’s concern, follow up with the PHQ-9 or a clinical assessment.

Statistical Measures for Major Depressive Disorder (7% Prevalence)

  • Sensitivity 97.6%

  • Specificity 59.2%

  • Positive Predictive Value* 15.4%

Statistical Measures for any Depressive Disorder (18% Prevalence)

  • Sensitivity 90.6%

  • Specificity 65.4%

  • Positive Predictive Value* 36.9%

Notes:

*Because the PPV varies with the prevalence of depression, the PPV will be higher in settings with a higher prevalence of depression and lower in settings with a lower prevalence.

Source: Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

PHQ-2 total score 2: Negative Screen. Depression unlikely.

The PHQ-2 also has no question about suicide or self-harm, so it can’t be used to assess safety. When there’s concern, follow up with the PHQ-9 or a clinical assessment.

Statistical Measures for Major Depressive Disorder (7% Prevalence)

  • Sensitivity 92.7%

  • Specificity 73.7%

  • Positive Predictive Value* 21.1%

Statistical Measures for any Depressive Disorder (18% Prevalence)

  • Sensitivity 82.1%

  • Specificity 80.4%

  • Positive Predictive Value* 48.3%

Notes:

*Because the PPV varies with the prevalence of depression, the PPV will be higher in settings with a higher prevalence of depression and lower in settings with a lower prevalence.

Source: Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

PHQ-2 total score 0: Negative Screen. Depression unlikely.

The PHQ-2 also has no question about suicide or self-harm, so it can’t be used to assess safety. When there’s concern, follow up with the PHQ-9 or a clinical assessment.

Citation

Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.

PHQ-9 is courtesy of an educational grant from Pfizer Inc. No permission is required to reproduce, translate, display or distribute.

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