PHQ-4: anxiety and depression symptom screen

Overview

The PHQ-4 is a four-question adult symptom screen. It combines two questions from the GAD-7 with two from the PHQ-9 and produces a total from 0 to 12. Survey Doctor's standard result reports one number: the total. It describes recent anxiety and depression distress but does not diagnose a disorder.

What the PHQ-4 measures

All four questions refer to the previous two weeks. Two ask about anxiety symptoms, and two ask about depression symptoms. Each response is scored from 0 to 3.

The original PHQ-4 study by Kroenke and colleagues (2009) describes both a total distress score and separate two-question anxiety and depression components. Survey Doctor's standard result shows one total from 0 to 12. It does not report either component.

Use the GAD-2 or PHQ-2 when a workflow needs a separately calculated screen for one of those symptom areas. Use a fuller assessment when the response will guide clinical decisions.

How PHQ-4 scoring works

Survey Doctor adds the four response values. The published total-score bands are:

The bands describe psychological distress. They do not establish which condition is present, whether symptoms have another cause, or what treatment is appropriate. Even a low total can miss an important concern when the relevant symptom is not among the four questions.

What the result does not show

Four questions leave important gaps.

The PHQ-4 does not provide a complete depression or anxiety assessment. It does not ask about sleep, appetite, energy, concentration, panic, trauma, substance use, functioning, suicide, or self-harm.

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.

Safety needs separate questions. Assess urgent symptoms directly. Do not infer current safety from the PHQ-4 total.

Survey Doctor's total also cannot tell you whether the anxiety component or depression component drove the result. If that distinction matters, follow with the GAD-7, PHQ-9, or a clinical interview chosen for the person's situation.

When the PHQ-4 is useful

The PHQ-4 can serve as a brief adult screen when a practice wants one opening measure for both symptom areas. It may also help a person summarize recent distress before a visit. Its value depends on having a clear process for reviewing the answers and deciding what assessment comes next.

The questionnaire should not be used as a stand-alone triage rule. A total in the highest band does not by itself define an emergency. A total in the lowest band does not prove that no care is needed.

Evidence from adult studies should not be assumed to apply unchanged to adolescents, a particular language, or a clinical population with different health conditions. Use a version and protocol supported for the intended group.

Repeating the PHQ-4

There is no universal repeat schedule. Choose timing according to the purpose of measurement, recent symptoms, risk, treatment context, and the setting's follow-up process. Keep the two-week recall period and administration method consistent when comparing totals.

A change in the total shows that the four responses changed. It does not prove why they changed, and Survey Doctor's total-only result cannot show which component accounted for the difference.

For a plain-language walkthrough, read what your PHQ-4 score means.

Key limits

• The PHQ-4 cannot diagnose a disorder.
• The standard result omits the component scores.
• It does not measure functioning or current safety.
• Bands do not prescribe treatment or urgency.
• Follow-up depends on the answers, context, and intended population.