PHQ-2 Questions, Scoring & Cutoff ≥3

The PHQ-2 is a 2-item depression screener made up of the first two items of the PHQ-9. Totals run from 0 to 6, and a score of 3 or more is a positive screen that calls for the full PHQ-9 ¹.

What does the PHQ-2 measure?

The PHQ-2 (Patient Health Questionnaire-2) asks how often, over the past 2 weeks, a person has been bothered by the two core symptoms of major depressive disorder: depressed mood and anhedonia (loss of interest or pleasure) ¹. It can be used as a first step to identify who should complete the full PHQ-9 ².

Each item is rated 0–3 by frequency (not at all, several days, more than half the days, nearly every day), giving a total of 0–6. A score of 3 or higher is a positive screen and calls for the full PHQ-9 and a clinical evaluation.

The PHQ-2 is part of the PHQ family of questionnaires (PHQ-9, PHQ-A, PHQ-SADS) developed by Drs. Spitzer, Kroenke, and Williams.

The PHQ-2 is a gateway screen, not a standalone diagnosis

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.

How do you give 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).

• Anhedonia: 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

• Give it at intake and as a periodic check at follow-up visits
• Proceed to the PHQ-9 promptly when the score is ≥3; do not defer to a later visit
• Clients can complete it themselves (paper, tablet, or digital), saving clinician time
• Always ask about suicidal ideation when the PHQ-2 is positive, regardless of PHQ-9 results

How do you score and interpret the PHQ-2?

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; the original study identified 3 as the optimal cutpoint for screening ¹.

When the PHQ-2 is positive (≥3)

Required follow-up steps:

• Give the full PHQ-9 (9 items) for severity scoring
• Ask directly about suicidal ideation (PHQ-9 item 9)
• Conduct a clinical interview to assess duration, impairment, and triggers
• Consider the GAD-7 for co-occurring anxiety

A negative PHQ-2 does not rule out depression

At the ≥3 cutoff, pooled sensitivity was 72% ², so some people with major depression screen negative. If clinical suspicion is high (e.g., the client reports sadness, sleep changes, or weight loss), give the full PHQ-9 regardless of the PHQ-2 score. Clinical judgment always supersedes a screening score.

Psychometric properties

In the original validation, 6,000 adults in 8 primary care and 7 obstetrics-gynecology clinics completed the PHQ-2. Functional status fell substantially as scores rose from 0 to 6. Against an independent structured mental health professional interview in 580 participants, a score of 3 or more had a sensitivity of 83% and a specificity of 92% for major depression ¹.

At the ≥3 threshold:

• Sensitivity: 83% in the original study ¹; pooled 72% among studies using semistructured interviews in an individual participant data meta-analysis of 44,318 participants ²
• Specificity: 92% in the original study ¹; pooled 85% in the meta-analysis ²

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 ².

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 ²; 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 client'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.

• Triage. In high-volume settings (primary care, urgent care, employee health), give the PHQ-2 to everyone; those who screen positive go on to the PHQ-9.
• Less burden. In the meta-analysis, a PHQ-2 of 2 or more followed by a PHQ-9 of 10 or more had similar sensitivity to the PHQ-9 alone, slightly higher specificity, and would cut the number of people completing the full PHQ-9 by 57% ².
• The PHQ-9 alone. On its own, a PHQ-9 cut-off of 10 or more maximized combined sensitivity (88%) and specificity (85%) against semistructured interviews ³.
• Monitoring. For measurement-based care focused on depression treatment, use the PHQ-9 directly at every visit rather than starting with the PHQ-2.

PHQ-2 scores belong in the Objective section of a SOAP note.

Billing the PHQ-2 (CPT 96127)

PHQ-2 administration qualifies for reimbursement under CPT code 96127 (brief emotional/behavioural assessment). Each unit represents one validated scale given, scored, and documented.

Medicare's Medically Unlikely Edit caps 96127 at 4 units per date of service; commercial payer limits vary, so confirm your contract. When the PHQ-2 is positive and you go on to the full PHQ-9, each scale can be billed as a separate 96127 unit in the same encounter.