PHQ-2 Questions, Scoring & Cutoff ≥3
The PHQ-2 (Patient Health Questionnaire-2) is a 2-item self-report questionnaire that screens for depression by asking about depressed mood and anhedonia over the past 2 weeks. A score of 3 or more (range 0–6) indicates the need for full PHQ-9 evaluation.
PHQ-2 Score Calculator
Enter each of the 2 items (0–3) to total them and see the band. Items are numbered, not reproduced — enter them from the form in front of you. Scoring aid only; it does not diagnose.
Score below 3 is a negative screen. The PHQ-2 has a high negative predictive value, though clinical judgment should guide further assessment when suspicion remains high.
0 of 2 items entered — 2 still blank. The total can only rise, so treat the band above as provisional.
- 0
- Not at all
- 1
- Several days
- 2
- More than half the days
- 3
- Nearly every day
Each item scores 0–3. Items are numbered, not reproduced — enter them from the form in front of you.
For reference only — not an assessment, diagnosis, or medical advice. This page provides scoring reference material; interpretation and clinical decisions rest with a qualified clinician.
PHQ-2 Screening Result Interpreter
Score ≥3 indicates a positive screen. Proceed to full PHQ-9 and clinical evaluation; ask directly about suicidal ideation. The PHQ-2 alone is not sufficient to diagnose depression.
2 items (depressed mood, anhedonia), each scored 0–3 based on frequency in the past 2 weeks. Total range 0–6. A single cutoff of ≥3 identifies a positive screen.
| Total score | Interpretation |
|---|---|
| 3+ | Positive screenScore ≥3 indicates a positive screen. Proceed to full PHQ-9 and clinical evaluation; ask directly about suicidal ideation. The PHQ-2 alone is not sufficient to diagnose depression. |
| 0–2 | Negative screenScore below 3 is a negative screen. The PHQ-2 has a high negative predictive value, though clinical judgment should guide further assessment when suspicion remains high. |
Kroenke K, Spitzer RL, Williams JBW. Med Care. 2003;41(11):1284–1292. Cutoff ≥3 identified as optimal screening threshold (sensitivity 83%, specificity 92% against structured clinical interview). Educational reference only — not a diagnostic tool.
For reference only — not an assessment, diagnosis, or medical advice. This page provides scoring reference material; interpretation and clinical decisions rest with a qualified clinician.
The PHQ-2 is a 2-item depression screener derived from the PHQ-9. With a score range of 0–6 and a ≥3 positive threshold, it identifies patients who need the full PHQ-9 in under 1 minute.
What the PHQ-2 measures
The PHQ-2 (Patient Health Questionnaire-2) consists of the first two questions of the PHQ-9, assessing the two core symptoms of major depressive disorder: anhedonia (loss of interest or pleasure) and depressed mood. Developed from the PRIME-MD diagnostic tool and validated by Kroenke et al. (2003), it is the recommended first-step depression screen in primary care, behavioural health integration, and population health programs.
Each item is rated 0–3 based on symptom frequency over the past 2 weeks (Not at all / Several days / More than half the days / Nearly every day), yielding a total score of 0–6. A score of 3 or higher is a positive screen and indicates the need for full PHQ-9 administration and clinical evaluation.
The PHQ-2 is part of the PHQ family of tools (PHQ-9, PHQ-A, PHQ-SADS) developed by Drs. Spitzer, Kroenke, and Williams. It is free to use (Pfizer, which holds the copyright, states that no permission is required to reproduce, translate, display or distribute it) and widely endorsed by USPSTF, APA, and primary care guidelines internationally.
PHQ-2 is a Gateway Screen, Not a Standalone Diagnostic
A positive PHQ-2 (≥3) requires follow-up with the full PHQ-9 and clinical evaluation. The PHQ-2 alone is not sufficient to diagnose depression or determine severity. It is designed as an efficient first step to identify who needs further assessment.
Copyright and Permissions
The PHQ-2 is copyrighted by Pfizer Inc. and is free to use; Pfizer states that no permission is required to reproduce, translate, display or distribute it.
How to administer the PHQ-2
Both questions ask about the past 2 weeks. Each is rated on a 4-point scale: 0 (Not at all), 1 (Several days), 2 (More than half the days), 3 (Nearly every day).
Over the past 2 weeks, how often have you been bothered by little interest or pleasure in doing things?
Depressed Mood
Over the past 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?
Administration Best Practices
- Administer at intake and as a periodic check at follow-up visits
- Proceed to PHQ-9 promptly when score ≥3, do not defer to a later visit
- Can be patient self-administered (paper, tablet, or digital), saving clinician time
- Always ask about suicidal ideation when PHQ-2 is positive, regardless of PHQ-9 results
Answer both questions based on how often you have been bothered over the past 2 weeks.
PHQ-2 scoring and interpretation
The two item scores (0–3 each) are summed for a total of 0–6. A total of 3 or higher is a positive screen; Kroenke et al. (2003) identified 3 as the optimal cutpoint for screening.
When PHQ-2 is Positive (≥3)
Required follow-up steps:
- Administer full PHQ-9 (9 items) for severity scoring
- Ask directly about suicidal ideation (PHQ-9 item 9)
- Conduct clinical interview to assess duration, impairment, and triggers
- Consider GAD-7 for comorbid anxiety (very common)
Negative PHQ-2 Doesn't Rule Out All Depression
The PHQ-2's NPV of 97% is excellent but not perfect. If clinical suspicion is high (e.g., patient reports sadness, sleep changes, or weight loss), administer the full PHQ-9 regardless of PHQ-2 score. Clinical judgment always supersedes a screening score.
Psychometric properties
In the original validation (Kroenke et al., 2003), 6,000 patients in 8 primary care and 7 obstetrics-gynecology clinics completed the PHQ-2. Functional status fell substantially as scores rose from 0 to 6, and against an independent structured mental health professional interview in 580 patients, a score of 3 or more had a sensitivity of 83% and a specificity of 92% for major depression.
At the ≥3 threshold (Kroenke et al., 2003):
- Sensitivity: 72–83% for major depression (pooled 72% among studies using semistructured interviews, Levis et al. 2020 JAMA individual participant data meta-analysis of 44,318 participants; original 2003 study: 83%)
- Specificity: 85–92% (pooled 85%, Levis et al. 2020; original 2003 study: 92%)
- PPV: 54% in primary care populations
- NPV: 97%, excellent for ruling out depression
A cutoff of 2 or more gave a pooled sensitivity of 91% and specificity of 67%, and the area under the ROC curve was 0.88 with semistructured interviews (Levis et al., 2020).
Limitations
- Screening, not diagnosis. A positive PHQ-2 identifies who needs the full PHQ-9 and a clinical interview; it does not diagnose depression or measure severity.
- Misses some cases. At the ≥3 cutoff, pooled sensitivity is 72%, so more than a quarter of people with major depression screen negative; use the full PHQ-9 when clinical suspicion is high.
- Narrow content. It asks only about depressed mood and anhedonia, and it does not ask about suicidal ideation.
- Self-report. Scores depend on the patient's recall of the past 2 weeks and willingness to disclose.
PHQ-2 vs PHQ-9: When to Use Each
The PHQ-2 and PHQ-9 are designed to work together as a two-stage screening and assessment protocol.
Clinical Guidance: The PHQ-2 functions as a triage gate. In high-volume settings (primary care, urgent care, employee health), administer PHQ-2 to all patients. Those who screen positive (≥3) proceed directly to PHQ-9. This two-stage approach reduces patient burden for the ~80% who screen negative while ensuring the PHQ-9's full diagnostic power is applied where it matters. For measurement-based care programs focused on depression treatment monitoring, use PHQ-9 directly at every visit rather than starting with PHQ-2.
Documenting PHQ-2 scores in clinical notes?
PHQ-2 scores belong in the Objective section of your note. See our SOAP notes guide and Intake Notes guide for templates and examples.
Billing the PHQ-2 (CPT 96127)
PHQ-2 administration qualifies for reimbursement under CPT code 96127 (brief emotional/behavioural assessment). Medicare's Medically Unlikely Edit caps 96127 at 4 units per date of service; commercial payer limits vary, so confirm your contract. Each unit represents one validated scale administered, scored, and documented. When the PHQ-2 is positive and you escalate to the full PHQ-9, both scales can each be billed as a separate 96127 unit in the same encounter.
HiBoop does not offer this scale. This page is reference material.This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Bill this assessment
In the US, the PHQ-2 Questions, Scoring & Cutoff ≥3 is usually billed under these CPT codes. Payer rules vary.
Measurement-based care in practice
For clinicians
HiBoop does not offer this scale. For the scales it does offer, responses are scored on submission and tracked over time, and HiBoop automates delivery across your patient panel.
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.
Frequently Asked Questions
What is a positive PHQ-2 score?
A PHQ-2 score of 3 or higher is considered a positive screen for depression. This cutoff was identified as the optimal threshold in the original 2003 validation study by Kroenke et al., with a sensitivity of 83% and a specificity of 92% against a structured clinical interview. A positive result indicates the need for full PHQ-9 administration and clinical evaluation.
Can the PHQ-2 diagnose depression?
No. The PHQ-2 is a screening tool, not a diagnostic test. A positive screen (≥3) identifies patients who need further evaluation with the full PHQ-9 and a clinical interview. Diagnosis of major depressive disorder requires a comprehensive clinical assessment that considers symptom duration, functional impairment, and differential diagnoses.
References
- 1.Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-1292.View source
- 2.Levis B, Sun Y, He C, et al.; Depression Screening Data (DEPRESSD) PHQ Collaboration. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis. JAMA. 2020;323(22):2290-2300.View source
- 3.Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.View source
Last reviewed: Jun 3, 2026
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