PHQ-2 Questions, Scoring & Cutoff ≥3

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 is the PHQ-2?

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 freely available in the public domain 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.

Public Domain

The PHQ-2 is in the public domain. No permissions, licensing fees, or royalties are required for clinical, educational, or research use.

The Two PHQ-2 Questions

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 & Interpretation

Sensitivity & Specificity

At the ≥3 threshold (Kroenke et al., 2003):

• Sensitivity: 76–83% for major depressive disorder (pooled ~76%, Levis et al. 2020 JAMA meta-analysis; original 2003 study: 83%)
• Specificity: 78–92% (varies by population)
• PPV: 54% in primary care populations
• NPV: 97%, excellent for ruling out depression

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.

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.