PHQ-4 totals run from 0 to 12: the published bands are 0-2 normal, 3-5 mild, 6-8 moderate, and 9-12 severe psychological distress. These bands are not diagnoses or treatment rules. Survey Doctor also shows a 0 to 6 score for the two anxiety questions and for the two depression questions.
PHQ-4 score ranges
| Total score | Published distress band |
|---|---|
| 0-2 | Normal |
| 3-5 | Mild |
| 6-8 | Moderate |
| 9-12 | Severe |
The labels describe the combined total from the PHQ-4; a normal-band result does not prove that nothing is wrong, while a severe-band result does not diagnose anxiety, depression, or another condition.
What the PHQ-4 total covers
The published PHQ-4 combines two anxiety symptom questions from the GAD-2 with two depression symptom questions from the PHQ-2. All four ask about the previous two weeks. The original adult primary care study linked higher totals with greater functional difficulty, more disability days, and more healthcare use.
The anxiety and depression scores
The published method also adds each pair of questions. The two anxiety questions give a score from 0 to 6, and so do the two depression questions. Survey Doctor shows both beside the total.
On either pair, 3 or more is the usual screening cutoff. A score that high is a good reason for a closer look at that symptom area. It is not a diagnosis, and a score below 3 does not rule anything out.
For the depression pair and its cutoff, see the PHQ-2 score guide.
How to use the result
Read the total and the two pair scores alongside your individual answers, symptoms, and daily functioning. A fuller assessment may help when symptoms persist, return often, or make work, relationships, sleep, or self-care harder.
The GAD-7 covers a broader set of anxiety symptoms. Consider it if the anxiety score is 3 or more, or anxiety is the main concern. The PHQ-9 covers a broader set of depression symptoms. Consider it if the depression score is 3 or more, or low mood or loss of interest is the concern. These are still screening and severity tools. They do not diagnose a condition or choose treatment on their own.
You do not need to wait for a particular band before discussing a concern with a healthcare professional. A marked change in functioning can matter even when a brief total is low.
What the score cannot tell you
The PHQ-4 cannot determine whether anxiety, depression, both, or another problem explains your symptoms. Four questions leave gaps. They cannot distinguish generalized anxiety, panic, trauma-related conditions, grief, medication effects, physical illness, or other possible causes.
The total also does not measure functioning directly. It cannot show why a score changed or whether a person has recovered. Clinical context matters more than a band alone.
When safety cannot wait
The PHQ-4 does not ask about suicide or self-harm. Get immediate help if you may act on these thoughts or cannot keep yourself safe. Do not wait for a higher score. Treat any other life-threatening emergency with the same urgency.
If you need help now. In the US, Call 988 or text 988. Call 911 if you are in immediate danger. Outside the US, contact your local emergency number or find support in your country.
Comparing PHQ-4 results over time
Use the same questionnaire and recall period if you repeat it. A lower score means the four answers added to a smaller total. It does not prove what caused the change. A higher score does not prove that one condition worsened.
Longer questionnaires cover more symptoms, but their totals are not interchangeable with the PHQ-4. Compare each measure only with earlier results from the same measure and consider symptoms, functioning, health changes, and major events.
The useful next step
Use the PHQ-4 total and pair scores to start a more specific conversation. The band describes overall distress across four symptoms. Your answers and circumstances determine what needs a closer look.