Assessment
PHQ-2: Patient Health Questionnaire-2
The PHQ-2 is a 2-question screen for depression, made of the first two items of the PHQ-9. It covers the last 2 weeks, takes under a minute, and gives a score from 0 to 6. A score of 3 or more should prompt the full PHQ-9 and a clinical interview. It screens; it does not diagnose.
- Questions
- 2
- Time
- Under 1 minute
- Recall period
- Past 2 weeks
- Score range
- 0 to 6
- Use
- First-step screen
Last updated
The MLC form, and using it with MLC Pro
This is the PHQ-2 as an MLC form: the questions on page 1, and how to score it on page 2. It is shown here for reference only, with credit to its authors, and the score table on page 2 is blurred. MLC does not sell it or offer it as a download. Therapists with MLC Pro can use it with their clients online.
- Assign it from the client's file in your dashboard, under Assigned Forms.
- The client completes it securely in their own portal.
- The total and the level are calculated for you, and you can download a PDF report that lists each answer.
What is the PHQ-2?
The Patient Health Questionnaire-2 (PHQ-2) is a very short screen for depression. Its two questions are the first two items of the PHQ-9 and ask how often, over the last 2 weeks, the person has been bothered by little interest or pleasure in doing things, and by feeling down, depressed, or hopeless. These are the two core symptoms of major depression. It was developed by Kroenke, Spitzer and Williams (2003).
It is built to be answered in seconds, so it can be used in any setting to decide whether the full PHQ-9 is needed.
For clients
It is two short questions about how you have felt over the past two weeks. Your answers help your therapist decide whether to ask you more. It is not a test you can pass or fail.
How do therapists use the PHQ-2?
The PHQ-2 supports a quick first screen for depression. A therapist reads it with the person's history, sleep, daily functioning and supports.
- Triage: a quick screen alongside mood and anxiety measures.
- Follow-up: a positive screen leads to the full PHQ-9 and a clinical interview.
- Busy settings: it takes under a minute, so it fits where the PHQ-9 would not.
How is the PHQ-2 completed?
The person rates how often each of the two problems has bothered them in the last 2 weeks: 0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day. It takes under a minute.
How is the PHQ-2 scored?
There is one total score, found in three steps.
- Give each of the two answers its number: Not at all is 0, Several days is 1, More than half the days is 2, Nearly every day is 3.
- Add the two numbers. The total runs from 0 to 6.
- Compare the total with the cut-off, below.
Example: if one answer is Several days (1) and the other is More than half the days (2), the total is 3, which is a positive screen.
What is the PHQ-2 cut-off score?
The score is read against a single cut-off.
| Result | Total score |
|---|---|
| Negative screen | 0 to 2 |
| Positive screen | 3 to 6 |
The PHQ instruction manual says a score of 3 or more should prompt giving the full PHQ-9 and a clinical interview to see whether a depressive disorder is present. The PHQ-2 does not measure severity.
A positive screen does not diagnose depression, and a negative screen does not rule it out.
Does the PHQ-2 measure suicide risk?
No. Neither of its questions asks about suicide or self-harm, so a clinician needs to ask about risk directly, whatever the score is. (The PHQ-9 has a question about it, which is another reason a positive PHQ-2 is followed by the PHQ-9.)
If you or someone you know is in distress or at risk right now, please see our crisis support page.
What are the limitations of the PHQ-2?
- It is a screen, not a diagnosis. Only a clinical assessment can diagnose depression.
- With only two items it will miss some people who have depression, and it will flag some who do not.
- It does not measure severity or track change well. Use the PHQ-9 for that.
- It covers the past 2 weeks only, and relies on the person's own answers.
- The best cut-off differs between populations, settings and languages.
How is the PHQ-2 different from the PHQ-9?
The PHQ-9 has nine questions and gives a score from 0 to 27 with five severity levels. The PHQ-2 is its first two questions only, with a score from 0 to 6 and a single cut-off.
Many services use the PHQ-2 as a first screen and give the PHQ-9 only when the PHQ-2 is positive. Others go straight to the PHQ-9.
How well does the PHQ-2 work?
In the original study (Kroenke and colleagues, 2003), a cut-off of 3 gave a reasonable balance between picking up depression and avoiding false alarms in primary care patients. It is less specific than the PHQ-9. As with any cut-off, how well it works depends on the group tested, so findings from one population should not be assumed to hold for another.
Frequently asked questions
What does PHQ-2 stand for?
PHQ-2 stands for Patient Health Questionnaire-2. It is a 2-question depression screen.
What does the PHQ-2 measure?
The PHQ-2 measures how often, over the last 2 weeks, a person has had little interest or pleasure in doing things, and has felt down, depressed, or hopeless, giving a total from 0 to 6.
How is the PHQ-2 scored?
Give each answer 0 to 3 (Not at all, Several days, More than half the days, Nearly every day) and add the two numbers. The total runs from 0 to 6.
What is the PHQ-2 cut-off score?
A score of 3 or more is a positive screen and should prompt the full PHQ-9 and a clinical interview.
What does a positive PHQ-2 mean?
It means depression is possible and the full PHQ-9 and a clinical interview are recommended. It is not a diagnosis.
How long does the PHQ-2 take?
Under a minute.
Is the PHQ-2 a diagnostic test?
No. The PHQ-2 is a quick screen. A diagnosis of depression needs a full clinical assessment.
What is the difference between the PHQ-2 and the PHQ-9?
The PHQ-2 is the first two questions of the PHQ-9. The PHQ-9 has nine questions, scores 0 to 27, and measures severity.
Does the PHQ-2 measure suicide risk?
No. Neither of its questions asks about suicide or self-harm, so a clinician needs to ask about risk directly whatever the score is.
Is the PHQ-2 free to use?
Yes. Its owners state that no permission is required to reproduce, translate, display or distribute the PHQ screeners. MLC shows its own form on this page for reference and does not sell it. It is available to therapists as an online form on MLC Pro.
How do I get the PHQ-2 on MLC?
Therapists with MLC Pro assign it directly to their clients from the dashboard, and clients complete it in their MLC portal.
Disclaimer and attribution
This page is for information. The PHQ-2 is a screening tool, not a standalone diagnostic instrument, and its results need professional interpretation in context. It is not a substitute for advice from a qualified health professional.
The PHQ-2 was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission is required to reproduce, translate, display or distribute it (phqscreeners.com). MLC does not claim ownership of this instrument.
References
- Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care, 41(11), 1284-1292 (2003).
- Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613 (2001).
- Instructions for Patient Health Questionnaire (PHQ) and GAD-7 Measures. Instruction manual, phqscreeners.com.
MLC Pro
Use the PHQ-2 with your clients on MLC Pro
The PHQ-2 is included with MLC Pro. Assign it directly to a client from their file in your dashboard, and the client completes it securely in their own portal.
- Open the client in your dashboard and choose Assigned Forms.
- Assign the PHQ-2 with an optional due date.
- Your client completes it in their portal. The score and the screen result are calculated automatically.
- You review the result and can download it as a PDF report. A positive screen can be followed by assigning the PHQ-9.
- Assign it again later if you need another screen.
Results are shared with the therapist who assigned it.