Question 1

What are the PHQ-4 total score severity ranges?

Accepted Answer

The PHQ-4 total score (0-12) is categorized as: Normal (0-2), Mild (3-5), Moderate (6-8), and Severe (9-12). The anxiety subscale (GAD-2, items 1-2) and depression subscale (PHQ-2, items 3-4) each use a cutoff of 3 or greater for a positive screen (Kroenke et al., 2009).

Question 2

What is the diagnostic accuracy of the PHQ-4 subscales?

Accepted Answer

The depression subscale (PHQ-2) has 83% sensitivity and 90% specificity for major depression at a cutoff of 3. The anxiety subscale (GAD-2) has 86% sensitivity and 83% specificity for GAD. Factor analysis confirmed two discrete factors accounting for 84% of variance (Kroenke et al., 2009).

Question 3

When should the PHQ-4 be used versus the full PHQ-9 and GAD-7?

Accepted Answer

The PHQ-4 is designed as an ultra-brief first-step screen where time is extremely limited. A positive screen on either subscale should be followed up with the full GAD-7 or PHQ-9 for severity assessment. The PHQ-4 is not intended to replace longer instruments for clinical monitoring.

Question 4

How does the PHQ-4 relate to functional impairment?

Accepted Answer

Increasing PHQ-4 scores are strongly associated with functional impairment, disability days, and healthcare utilization. Patients in the severe range (9-12) reported significantly more disability days and clinic visits, supporting its clinical utility as a marker of overall psychological distress (Kroenke et al., 2009).

Question 5

What does my PHQ-4 score mean?

Accepted Answer

We have a detailed scoring guide that explains how to interpret your PHQ-4 results, including severity ranges and recommended clinical actions. Read our full scoring guide.

PHQ-4: Ultra-Brief Screening for Anxiety and Depression

Take the PHQ-4 assessment. Ultra-brief 4-item screening combining anxiety and depression assessment. Evidence-based dual screening tool.

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