Patient Health Questionnaire‐4 (PHQ‐4)

Clinical intent

This workflow supports structured collection of questionnaire/test inputs to generate a validated clinical score for use in routine assessment and follow-up.

Calculation

Anxiety score

Anxiety score is determined by adding together the scores of the first 2 items.

Depression score

Depression score is determined by adding together the scores of the last 2 items.

Total score

Total score is determined by adding together the scores of each of the 4 items.

Clinical interpretation

Anxiety score

A score ≥3 suggests anxiety.

Depression score

A score ≥3 suggests depression.

Total score

Scores are rated as normal (0-2), mild (3-5), moderate (6-8), and severe (9-12).

References

[1] Löwe B, Wahl I, Rose M, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. Journal of Affective Disorders 2010, 122 (1-2): 86-95

[2] Kroenke, K., Spitzer, R. L., Williams, J. B. W., Löwe, B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics 2009, 50 (6): 613-21

[3] Spitzer RL, Williams JBW, Kroenke K, Linzer M, deGruy FV, Hahn SR, Brody D, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care: ThePRIME-MD 1000 study. JAMA 1994 December 14, 272 (22): 1749-56

[4] Arroll B, Goodyear-smith F, Crengle S, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine 2010, 8 (4): 348-53

[5] Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care 2003, 41 (11): 1284-92