PHQ-4
Patient Health Questionnaire-4
An ultra-brief combined screen for anxiety and depression.
4
1 min
adult
0–12
About the PHQ-4
The Patient Health Questionnaire-4 (PHQ-4) combines the two-item PHQ-2 depression screen with the two-item GAD-2 anxiety screen into a single four-item measure of psychological distress. It gives clinicians a fast read on both of the most common presentations in one questionnaire.
Each item is rated 0–3 over the past two weeks for a total score of 0–12, with separate anxiety and depression subscores of 0–6. Total scores of 3, 6, and 9 mark mild, moderate, and severe distress respectively.
What it measures
- Anxiety subscale: feeling nervous and being unable to stop worrying (GAD-2)
- Depression subscale: anhedonia and depressed mood (PHQ-2)
- A combined total distress score
PHQ-4 questions
- 1
Feeling nervous, anxious, or on edge
anxiety - 2
Not being able to stop or control worrying
anxiety - 3
Little interest or pleasure in doing things
depression - 4
Feeling down, depressed, or hopeless
depression
Items reproduced from a documented, freely usable source. Item wording is preserved exactly as published.
Scoring & interpretation
| Range | Band | Interpretation |
|---|---|---|
| 0–2 | Normal | Below screening threshold. |
| 3–5 | Mild | Mild psychological distress. |
| 6–8 | Moderate | Moderate distress — clinical review recommended. |
| 9–12 | Severe | Severe distress — administer PHQ-9 and GAD-7 and refer. |
Higher scores indicate greater symptom severity.
anxiety subscale
| Range | Band |
|---|---|
| 0–2 | Below threshold |
| 3–6 | Positive screen |
depression subscale
| Range | Band |
|---|---|
| 0–2 | Below threshold |
| 3–6 | Positive screen |
Clinical applications
- Single-page screening for the two most common mental-health presentations
- Routine intake and review in primary care, integrated care, and digital health
- A brief distress thermometer that flags who needs a fuller assessment
Frequently asked questions
What does the PHQ-4 screen for?
It screens for both anxiety (via the GAD-2 items) and depression (via the PHQ-2 items), and yields a combined distress score.
What is a high PHQ-4 score?
Total scores of 6–8 indicate moderate and 9–12 severe psychological distress. A subscale score of 3 or more on either pair is a positive screen for that domain.
Source & references
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