Psychiatry
PHQ-2 (Depression Screen)
Two-item depression screen.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The PHQ-2 is an ultra-brief, two-item depression screen taken from the Patient Health Questionnaire. It asks how often, over the past two weeks, the person has been bothered by little interest or pleasure in doing things, and by feeling down, depressed or hopeless, each scored 0–3 for a total of 0–6. The two items map onto the core symptoms of depression — anhedonia and low mood. It is designed as a first-step filter rather than a diagnostic instrument.
Interpreting the result
A total of 0–2 is a negative screen and 3 or more is positive, the threshold at which a fuller assessment such as the PHQ-9 or a clinical interview is recommended. The cut-off of 3 favours sensitivity, so a positive result identifies people who need further evaluation rather than confirming depression. A negative screen makes depression less likely but does not exclude it where clinical suspicion remains.
Worked example
A patient reports little interest or pleasure for more than half the days (+2) and feeling down nearly every day (+3), totalling 5. This is a positive screen, so they should go on to a fuller assessment such as the PHQ-9 to characterise severity and confirm the diagnosis.
Pearls / pitfalls
- It is a screen, not a diagnosis — a positive result must be followed by a fuller assessment before treatment decisions.
- The cut-off of 3 prioritises sensitivity, so expect some false positives; that is by design for a filtering test.
- A negative screen does not exclude depression when clinical concern persists, for example with prominent somatic symptoms or risk factors.
- Neither PHQ item asks about self-harm; always assess suicide risk separately when depression is suspected.
Evidence & validation
Derived and validated by Kroenke, Spitzer and Williams in 2003, the PHQ-2 showed good sensitivity for major depression at a cut-off of 3 when validated against structured interviews. It is widely used as a first-step screen in primary care and general medical settings, typically followed by the PHQ-9 when positive.
Frequently asked questions
What PHQ-2 score is positive?
A total of 3 or more out of 6 is a positive screen and should prompt a fuller assessment such as the PHQ-9. Scores of 0–2 are negative.
Does a positive PHQ-2 mean the person has depression?
No. It only flags the need for further evaluation. A positive screen should lead to a fuller assessment or clinical interview before any diagnosis is made.
What should I do after a positive PHQ-2?
Move on to a more detailed tool such as the PHQ-9 or a clinical assessment to gauge severity and confirm the diagnosis, and assess risk. The PHQ-2 alone does not characterise the illness.
Does the PHQ-2 ask about suicide?
No. Neither item covers self-harm, so suicide risk must be assessed separately whenever depression is suspected, regardless of the PHQ-2 result.
Can a negative PHQ-2 rule out depression?
It makes depression less likely but does not exclude it. If clinical suspicion remains, proceed to fuller assessment despite a negative screen.
References
- 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.
- NICE NG222: Depression in adults: treatment and management. 2022.
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