PHQ-2: two-question depression screen

Overview

The PHQ-2 is a two-question adult depression screen about low mood and loss of interest during the past two weeks. Scores run from 0 to 6. A score of 3 or higher calls for a fuller assessment, often with the PHQ-9. Neither a high nor a low score establishes a diagnosis.

What the PHQ-2 measures

The PHQ-2 uses the first two symptom questions from the PHQ-9. One asks about depressed mood. The other asks about loss of interest or pleasure, which clinicians call anhedonia. Each answer describes how often the symptom occurred during the previous two weeks.

The questionnaire is intended as a first step for adults. It does not cover sleep, appetite, energy, concentration, movement, guilt, functioning, suicide, or self-harm.

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If a person has other concerning symptoms, marked functional change, or a safety concern, assess those directly instead of relying on the PHQ-2 total.

How PHQ-2 scoring works

Each question is scored from 0 to 3, so the total ranges from 0 to 6. Survey Doctor displays two result groups:

Crossing the cutoff triggers follow-up. It does not mean that major depressive disorder is likely for that individual, and it does not select a treatment.

Evidence behind the cutoff

In the original adult validation, 580 primary care and obstetrics-gynecology patients completed an independent mental health interview. At a cutoff of 3, the PHQ-2 had 82.9% sensitivity and 90.0% specificity for major depressive disorder. Its positive predictive value was 38.4% in that sample. These figures come from Kroenke and colleagues (2003), and performance can differ in other settings and populations.

That positive predictive value is an important limit. Most participants who crossed the cutoff in the validation subsample did not have major depressive disorder on the structured interview. The score identified people who needed further evaluation; it did not diagnose them.

When the PHQ-2 is useful

The PHQ-2 can reduce the burden of an initial adult screen when a clinic has a reliable next step for positive results. It can also help open a conversation when someone is unsure how to describe a recent change in mood or interest.

The shorter form trades detail for speed. Use the PHQ-9 when the care plan requires a broader depression symptom profile, a severity total, or direct follow-up on its death and self-harm item.

Do not extend the adult evidence to adolescents or other specific populations without a protocol supported for that group.

What a low score can miss

A low score can still miss important symptoms. This can happen when they fall outside the two questions, have been present for less than two weeks, or are serious but infrequent. The PHQ-2 also does not ask how symptoms affect work, relationships, self-care, or daily responsibilities.

Follow the person's symptoms and circumstances. A clinician may continue the assessment despite a low total when there is functional decline, a prior depressive episode, a recent major stressor, a medical concern, or a safety concern.

How often to repeat it

There is no single evidence-based interval that fits every adult. The USPSTF adult depression screening recommendation (2023) found no evidence for one optimal screening frequency. Clinics should set timing according to risk, symptoms, life events, treatment context, and their ability to assess and support people after a positive result.

When repeating the PHQ-2, keep the two-week recall period unchanged and interpret movement alongside symptoms and functioning. A score change alone cannot show what caused the change.

For a plain-language walkthrough, read what your PHQ-2 score means.

Key limits

• The PHQ-2 cannot diagnose depression.
• A low result does not rule depression out.
• A result at or above the cutoff calls for assessment, not automatic treatment.
• The total does not measure functioning or current safety.
• Accuracy varies by population.