[{"data":1,"prerenderedAt":340},["ShallowReactive",2],{"assessment-phq-4":3,"assessments-related-phq-4":318},{"id":4,"title":5,"body":6,"category":237,"categoryTitle":238,"clinicalCitations":239,"copyright":252,"description":253,"downloadLink":237,"extension":254,"faqs":255,"featured":268,"firstPublished":269,"i18nReady":268,"icon":237,"inHiBoop":237,"interpreter":270,"interpreterExempt":237,"lastReviewed":306,"meta":307,"navigation":308,"path":309,"permissionsNote":237,"published":308,"recommendedFrequency":237,"relatedCodes":237,"relatedConditions":237,"relevantSpecialty":237,"reviewedBy":237,"seo":310,"slug":311,"status":312,"stem":313,"summary":314,"takeaways":237,"timeline":237,"type":315,"usedToDiagnose":316,"__hash__":317},"assessments\u002Fassessments\u002Fphq-4.md","PHQ-4 Scoring · Anxiety and Depression Screen (0-12, Subscale Cutoff ≥3)",{"type":7,"value":8,"toc":227},"minimark",[9,22,27,36,70,73,77,117,121,155,158,162,189,193],[10,11,12,13,17,18,21],"p",{},"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 ",[14,15],"cite-ref",{"n":16},"1"," ",[14,19],{"n":20},"3",".",[23,24,26],"h2",{"id":25},"what-does-the-phq-4-measure","What does the PHQ-4 measure?",[10,28,29,30,32,33,35],{},"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 ",[14,31],{"n":16},". It was built by combining two validated ultra-brief screens ",[14,34],{"n":16},":",[37,38,39,58],"ul",{},[40,41,42,46,47,52,53,57],"li",{},[43,44,45],"strong",{},"Depression (PHQ-2)."," Depressed mood and loss of interest or pleasure, the first two items of the ",[48,49,51],"a",{"href":50},"\u002Fassessments\u002Fphq-9\u002F","PHQ-9",". See the ",[48,54,56],{"href":55},"\u002Fassessments\u002Fphq-2\u002F","PHQ-2"," page.",[40,59,60,63,64,17,68,21],{},[43,61,62],{},"Anxiety (GAD-2)."," Nervousness and uncontrollable worry, the first two items of the ",[48,65,67],{"href":66},"\u002Fassessments\u002Fgad-7\u002F","GAD-7",[14,69],{"n":20},[10,71,72],{},"The total reflects overall psychological distress; the subscales point to which kind.",[23,74,76],{"id":75},"how-do-you-give-the-phq-4","How do you give the PHQ-4?",[37,78,79,85,93,101,107],{},[40,80,81,84],{},[43,82,83],{},"Who completes it."," The client, on paper or a digital form.",[40,86,87,90,91,21],{},[43,88,89],{},"Time window."," The past 2 weeks ",[14,92],{"n":20},[40,94,95,98,99,21],{},[43,96,97],{},"Response scale."," Each item is rated 0 (not at all), 1 (several days), 2 (more than half the days) or 3 (nearly every day) ",[14,100],{"n":20},[40,102,103,106],{},[43,104,105],{},"Length."," Four items, two per subscale.",[40,108,109,112,113,116],{},[43,110,111],{},"Permissions."," Pfizer states that no permission is required to reproduce, translate, display or distribute the PHQ screeners ",[14,114],{"n":115},"4",". Use the published form; the items are not reproduced on this page.",[23,118,120],{"id":119},"how-do-you-score-and-interpret-the-phq-4","How do you score and interpret the PHQ-4?",[122,123,124,127,132,137],"ol",{},[40,125,126],{},"Add the four item ratings for a total from 0 to 12.",[40,128,129,130,21],{},"Read the total as normal (0 to 2), mild (3 to 5), moderate (6 to 8) or severe (9 to 12) ",[14,131],{"n":20},[40,133,134,135,21],{},"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 ",[14,136],{"n":20},[40,138,139,140,144,145,149,150,154],{},"Follow a positive depression subscale with the full PHQ-9, and a positive anxiety subscale with the full GAD-7. The ",[48,141,143],{"href":142},"\u002Finsights\u002Fphq9-vs-gad7-decision-tree\u002F","PHQ-9 vs GAD-7 decision tree"," covers which to give first; the ",[48,146,148],{"href":147},"\u002Fassessments\u002Fcompare\u002F","assessment comparison"," and the ",[48,151,153],{"href":152},"\u002Finsights\u002Fassessment-tools-guide\u002F","assessment tools guide"," set wider choices side by side.",[10,156,157],{},"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.",[23,159,161],{"id":160},"psychometric-properties","Psychometric properties",[37,163,164,172,181],{},[40,165,166,169,170,21],{},[43,167,168],{},"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 ",[14,171],{"n":16},[40,173,174,177,178,21],{},[43,175,176],{},"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 ",[14,179],{"n":180},"2",[40,182,183,186,187,21],{},[43,184,185],{},"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 ",[14,188],{"n":20},[23,190,192],{"id":191},"limitations","Limitations",[37,194,195,201,209,215,221],{},[40,196,197,200],{},[43,198,199],{},"Screening, not diagnosis."," A positive subscale identifies who needs the full PHQ-9 or GAD-7 and a clinical interview.",[40,202,203,206,207,21],{},[43,204,205],{},"No criterion interview in the norms."," The German general population study did not include a diagnostic interview ",[14,208],{"n":180},[40,210,211,214],{},[43,212,213],{},"Narrow content."," Two items per condition cover only the core symptoms; it does not ask about suicidal thoughts, sleep, or physical symptoms.",[40,216,217,220],{},[43,218,219],{},"Total and subscales differ."," The total severity ranges describe overall distress; a positive screen is defined per subscale.",[40,222,223,226],{},[43,224,225],{},"Self-report."," Scores depend on recall of the past 2 weeks and willingness to disclose.",{"title":228,"searchDepth":229,"depth":229,"links":230},"",3,[231,233,234,235,236],{"id":25,"depth":232,"text":26},2,{"id":75,"depth":232,"text":76},{"id":119,"depth":232,"text":120},{"id":160,"depth":232,"text":161},{"id":191,"depth":232,"text":192},null,"Depression & Mood",[240,243,246,249],{"text":241,"link":242},"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.","https:\u002F\u002Fdoi.org\u002F10.1176\u002Fappi.psy.50.6.613",{"text":244,"link":245},"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.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F19616305\u002F",{"text":247,"link":248},"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.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F32560705\u002F",{"text":250,"link":251},"Pfizer Inc. Patient Health Questionnaire (PHQ) Screeners: select a screener.","https:\u002F\u002Fwww.phqscreeners.com\u002Fselect-screener","PHQ-4 © Pfizer Inc. No permission is required to reproduce, translate, display or distribute it.","PHQ-4 scoring guide: 4-item anxiety and depression screen, total 0 to 12 with normal to severe ranges, and the ≥3 cutoff on the PHQ-2 and GAD-2 subscales.","md",[256,259,262,265],{"question":257,"answer":258},"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.",{"question":260,"answer":261},"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.",{"question":263,"answer":264},"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.",{"question":266,"answer":267},"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.",false,"2009",{"heading":271,"scaleLabel":272,"min":273,"max":274,"note":275,"source":276,"calculator":277,"bands":287},"PHQ-4 Score Interpreter","Total score",0,12,"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 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).",{"itemCount":278,"maxPerItem":229,"heading":279,"itemLabel":280,"anchors":281,"note":286},4,"PHQ-4 Score Calculator","PHQ-4 items",[282,283,284,285],"Not at all","Several days","More than half the days","Nearly every day","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.",[288,293,298,302],{"min":289,"label":290,"level":291,"note":292},9,"Severe","error","9 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.",{"min":294,"label":295,"level":296,"note":297},6,"Moderate","warning","6 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.",{"min":229,"label":299,"level":300,"note":301},"Mild","info","3 to 5 is in the mild range. Check each subscale: 3 or more on either 2-item half is still a positive screen.",{"min":273,"label":303,"level":304,"note":305},"Normal","success","0 to 2 is in the normal range, and neither subscale can reach the cutoff of 3.","2026-10-29",{},true,"\u002Fassessments\u002Fphq-4",{"title":5,"description":253},"phq-4","published","assessments\u002Fphq-4","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.","assessment","Depression and anxiety disorders","0LGvqugGVT9Nd_bKBjCK2cYtR_x454Zme8jNtQLn-O8",[319,324,327,330,334,337],{"slug":320,"title":321,"tier":322,"weight":323},"bdi-ii","BDI-II Scoring Guide · Beck Depression Inventory","same",100,{"slug":325,"title":326,"tier":322,"weight":323},"ces-d","CES-D: Center for Epidemiologic Studies Depression Scale",{"slug":328,"title":329,"tier":322,"weight":323},"ces-dc","CES-DC Scoring · Center for Epidemiologic Studies Depression Scale for Children",{"slug":331,"title":332,"tier":43,"weight":333},"bai","Beck Anxiety Inventory (BAI) Scoring & Interpretation",65,{"slug":335,"title":336,"tier":43,"weight":333},"gad-7","GAD-7 Scoring and Interpretation",{"slug":338,"title":339,"tier":43,"weight":333},"ham-a","HAM-A: Hamilton Anxiety Rating Scale",1793342509834]