PHQ-2 and GAD-2 Screeners
The two-item PHQ-2 and GAD-2 ultra-brief screeners for depression and anxiety, reproduced in full with their cut-offs, the combined PHQ-4 scoring, interpretation notes and licence information.
About this resource
The PHQ-2 consists of the first two items of the PHQ-9, covering depressed mood and loss of interest or pleasure, the two cardinal symptoms of major depression. The GAD-2 consists of the first two items of the GAD-7, covering nervousness and uncontrollable worry. Each is scored 0 to 6. Together they form the PHQ-4, a four-item screen scored 0 to 12 that gives a quick indication of overall emotional distress.
These screeners are designed for settings where time is short: intake forms, waiting rooms, primary care and routine check-ins. They are first-stage screens. A positive result (a score of 3 or more on either two-item scale) should be followed by the full PHQ-9 or GAD-7 and a clinical conversation. In the original validation the PHQ-2 at a cut-off of 3 had a sensitivity of 83% and a specificity of 92% for major depression, and the GAD-2 at a cut-off of 3 had a sensitivity of 86% and a specificity of 83% for generalized anxiety disorder.
The professional version adds the PHQ-4 scoring bands, guidance on the two-stage screening approach, and the limitations of two-item measures, notably their inability to detect risk.
The instruments are reproduced here because Pfizer, the copyright holder, permits reproduction, translation, display and distribution of the PHQ family without permission.
How to use it
- Use the PHQ-2 and GAD-2 as a first-stage screen at intake or in settings where the full measures are impractical.
- Score each two-item scale by summing its items (0 to 6). A score of 3 or more on either scale is a positive screen.
- Follow any positive screen with the full PHQ-9 or GAD-7 and a clinical assessment. Do not base a diagnosis or treatment decision on the two-item scales alone.
- If using the combined PHQ-4, sum all four items (0 to 12) and use the bands in the scoring table to describe overall distress.
- Remember that the PHQ-2 does not include the PHQ-9's item on thoughts of death or self-harm. Ask about risk directly whenever the screen is positive or whenever clinical judgement suggests it.
References
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284-1292.
- Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317-325.
- Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50(6), 613-621.
