Interactive Interpreter

PHQ-4 Scoring · Anxiety and Depression Screen (0-12, Subscale Cutoff ≥3)

The PHQ-4 (Patient Health Questionnaire-4) is a 4-item self-report screen for anxiety and depression that combines the PHQ-2 and the GAD-2, over the past 2 weeks. Totals run 0 to 12 (0-2 normal, 3-5 mild, 6-8 moderate, 9-12 severe), and a score of 3 or more on either 2-item subscale is a positive screen.

For professional reference, research, and education only. Not for diagnosis or medical advice.

PHQ-4 Score Interpreter

  • PHQ-4 Score Calculator

    Enter each of the 4 items (0–3) to total them and see the band. Items are numbered, not reproduced: enter them from the form in front of you. Score the two depression and two anxiety items separately as well. Scoring aid only; it does not diagnose.

    0 of 4 items entered — 4 still blank. The total can only rise, so treat the range as provisional.

    Item 1
    Item 2
    Item 3
    Item 4

    Each item scores 0–3.

  • Enter a total score to see its range.

  • 4 items, each 0 (not at all) to 3 (nearly every day) for the past 2 weeks; total 0 to 12. Also check each 2-item subscale: 3 or more on the depression items (PHQ-2) or the anxiety items (GAD-2) is a positive screen.

    Total scoreInterpretation
    9+Severe9 to 12 is in the severe range of psychological distress. Check each subscale, give the full PHQ-9 and GAD-7 as indicated, and complete a clinical assessment.
    6–8Moderate6 to 8 is in the moderate range. At least one subscale is likely to be 3 or more; follow a positive subscale with the full PHQ-9 or GAD-7.
    3–5Mild3 to 5 is in the mild range. Check each subscale: 3 or more on either 2-item half is still a positive screen.
    0–2Normal0 to 2 is in the normal range, and neither subscale can reach the cutoff of 3.

    Total score categories (0-2 normal, 3-5 mild, 6-8 moderate, 9-12 severe) and the subscale cutoff of 3 per Kroenke et al. (2009), as reported by Materu et al. (2020).

The PHQ-4 (Patient Health Questionnaire-4) is a 4-item screen made of the 2-item PHQ-2 for depression and the 2-item GAD-2 for anxiety. Totals run 0 to 12, and each 2-item subscale has a cutoff of 3 [1] [3].

What does the PHQ-4 measure?

The PHQ-4 screens for depression and anxiety together, the two most common mental disorders in outpatient settings and the general population, which often co-occur [1]. It was built by combining two validated ultra-brief screens [1]:

  • Depression (PHQ-2). Depressed mood and loss of interest or pleasure, the first two items of the PHQ-9. See the PHQ-2 page.
  • Anxiety (GAD-2). Nervousness and uncontrollable worry, the first two items of the GAD-7 [3].

The total reflects overall psychological distress; the subscales point to which kind.

How do you give the PHQ-4?

  • Who completes it. The client, on paper or a digital form.
  • Time window. The past 2 weeks [3].
  • Response scale. Each item is rated 0 (not at all), 1 (several days), 2 (more than half the days) or 3 (nearly every day) [3].
  • Length. Four items, two per subscale.
  • Permissions. Pfizer states that no permission is required to reproduce, translate, display or distribute the PHQ screeners [4]. Use the published form; the items are not reproduced on this page.

How do you score and interpret the PHQ-4?

  1. Add the four item ratings for a total from 0 to 12.
  2. Read the total as normal (0 to 2), mild (3 to 5), moderate (6 to 8) or severe (9 to 12) [3].
  3. Add the two depression items (PHQ-2, 0 to 6) and the two anxiety items (GAD-2, 0 to 6) separately. A subscale score of 3 or more is a positive screen for that half [3].
  4. Follow a positive depression subscale with the full PHQ-9, and a positive anxiety subscale with the full GAD-7. The PHQ-9 vs GAD-7 decision tree covers which to give first; the assessment comparison and the assessment tools guide set wider choices side by side.

A mild total can still hide a positive subscale: a total of 3 made of 3 on the anxiety items and 0 on the depression items is a positive anxiety screen.

Psychometric properties

  • Original study. In 2,149 patients from 15 primary care clinics in the United States, factor analysis confirmed two separate factors, depression and anxiety, that explained 84% of the total variance. Higher PHQ-4 scores were strongly associated with functional impairment, disability days and health care use, and anxiety affected functional status independently of depression [1].
  • General population. In a nationally representative German survey of 5,030 adults, confirmatory factor analysis supported the two-factor structure (RMSEA .027), which held across age and gender groups. A PHQ-2 score of 3 corresponded to the 93.4th percentile and a GAD-2 score of 3 to the 95.2nd percentile [2].
  • Young women in Tanzania. In 2,426 out-of-school adolescent girls and young women aged 15 to 23, Cronbach's α for the PHQ-4 was 0.81 [3].

Limitations

  • Screening, not diagnosis. A positive subscale identifies who needs the full PHQ-9 or GAD-7 and a clinical interview.
  • No criterion interview in the norms. The German general population study did not include a diagnostic interview [2].
  • Narrow content. Two items per condition cover only the core symptoms; it does not ask about suicidal thoughts, sleep, or physical symptoms.
  • Total and subscales differ. The total severity ranges describe overall distress; a positive screen is defined per subscale.
  • Self-report. Scores depend on recall of the past 2 weeks and willingness to disclose.

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • How is the PHQ-4 scored?

    Each of the 4 items is rated 0 (not at all), 1 (several days), 2 (more than half the days) or 3 (nearly every day) for the past 2 weeks. Add all four for a total from 0 to 12. Add the two depression items for the PHQ-2 subscale and the two anxiety items for the GAD-2 subscale, each 0 to 6.

  • What is a positive PHQ-4 score?

    A score of 3 or more on the two anxiety items (GAD-2) or on the two depression items (PHQ-2) is a positive screen for that subscale. The total is read as normal (0 to 2), mild (3 to 5), moderate (6 to 8) or severe (9 to 12) psychological distress.

  • What is the difference between the PHQ-4, PHQ-2 and GAD-2?

    The PHQ-4 is the PHQ-2 depression screen and the GAD-2 anxiety screen given together. The PHQ-2 asks about depressed mood and loss of interest; the GAD-2 asks about nervousness and uncontrollable worry. Each half is scored on its own as well as in the total.

  • What should follow a positive PHQ-4?

    Follow a positive depression subscale with the full PHQ-9, and a positive anxiety subscale with the full GAD-7, then a clinical interview. The PHQ-4 does not ask about suicidal thoughts, so ask directly when depression screens positive.

References

    1. 1.Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613-21.
    2. 2.Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, Schneider A, Brähler E. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122(1-2):86-95.
    3. 3.Materu J, Kuringe E, Nyato D, Galishi A, Mwanamsangu A, Katebalila M, Shao A, Changalucha J, Nnko S, Wambura M. The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: a cross-sectional study. BMC Psychiatry. 2020;20(1):321.
    4. 4.Pfizer Inc. Patient Health Questionnaire (PHQ) Screeners: select a screener.

    PHQ-4 © Pfizer Inc. No permission is required to reproduce, translate, display or distribute it.

HiBoop does not offer this scale. This page is reference material.

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