Patient Health Questionnaire-2
Also known as: PHQ-2, Patient Health Questionnaire
The Patient Health Questionnaire-2 (PHQ-2) is an ultra-brief, validated two-item screening instrument developed by Kroenke and colleagues in 2003 to identify major depression in primary care and medical populations. The PHQ-2 assesses the two cardinal symptoms of depression (depressed mood and anhedonia) over the past two weeks using a 0-3 frequency scale. It is the shortest validated depression screening tool enabling routine use in time-constrained clinical settings.
Key highlights
- Exceptionally brief (2 items, 30 seconds) enabling universal screening even in time-constrained settings
- Excellent sensitivity and specificity for major depressive disorder compared to diagnostic interview
- Based on DSM diagnostic criteria ensuring alignment with clinical diagnosis
- Extensively validated across diverse medical populations including primary care, general medicine, and specialty care
Intuition
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How it works
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When to use it
PHQ-2 is indicated for rapid depression screening in any medical setting where systematic identification of depression would improve care. Use in primary care annual health maintenance, medical subspecialty clinics (cardiology, oncology, diabetes), emergency medicine, and inpatient hospital settings. Particularly valuable in settings where time constraints limit comprehensive psychiatric assessment but screening could identify patients needing referral.
Strengths & limitations
- Exceptionally brief (2 items, 30 seconds) enabling universal screening even in time-constrained settings
- Excellent sensitivity and specificity for major depressive disorder compared to diagnostic interview
- Based on DSM diagnostic criteria ensuring alignment with clinical diagnosis
- Extensively validated across diverse medical populations including primary care, general medicine, and specialty care
- Screening tool only; positive PHQ-2 requires comprehensive assessment (PHQ-9, diagnostic interview) to confirm major depression diagnosis
- Does not assess suicide risk; positive screens should include suicide assessment before deciding on management
- May miss depression presentations focused on somatic symptoms rather than mood; some medically ill patients experience depression primarily as worsening medical symptoms
Common pitfalls
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Applications
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Frequently asked
What should I do if a patient screens positive on PHQ-2?
Positive PHQ-2 (score 3 or higher) warrants further assessment. Administer the full PHQ-9 to assess additional depressive symptoms and suicide risk. Ask directly about suicidal thoughts: 'Are you having thoughts of harming yourself?' If suicide risk is present, assess imminence and access to means, involve emergency services if needed. Consider referral to mental health specialist for diagnosis confirmation and treatment planning.
Can PHQ-2 be used to monitor depression treatment over time?
PHQ-2 can be used for basic screening repeatedly, but the PHQ-9 is more appropriate for monitoring treatment response because it assesses all nine depressive symptoms and is more sensitive to change. Use PHQ-2 for initial screening and periodic check-in, but switch to PHQ-9 after diagnosis to track symptom improvement during treatment.
Is PHQ-2 valid in older adults and medically ill patients?
Yes, PHQ-2 is valid in older adults and medical populations where depression is common. However, interpretation requires clinical judgment: medically ill patients may endorse depressive symptoms due to medical illness or medications rather than primary depression. Assessment should distinguish depression as primary condition from depression secondary to medical illness or medication effects.
Sources
- 1.Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care, 41(11), 1284-1292.
- 2.Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA, 282(18), 1737-1744.
- 3.Li, C., Friedman, B., Conwell, Y., & Fiscella, K. (2007). Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. Journal of the American Geriatrics Society, 55(4), 596-602.
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ScholarGate. (2026, June 3). Patient Health Questionnaire-2. ScholarGate. https://scholargate.app/health-services/patient-health-questionnaire-2