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The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener

Kroenke, Kurt MD*; Spitzer, Robert L. MD; Williams, Janet B. W. DSW

doi: 10.1097/01.MLR.0000093487.78664.3C
Original Articles

Background.  A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2.

Methods.  The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 (“not at all”) to 3 (“nearly every day”). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics–gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.

Results.  As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score ≥3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics–gynecology samples.

Conclusion.  The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.

From the *Regenstrief Institute for Health Care and Department of Medicine, Indiana University, Indianapolis, Indiana.

From the †New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY.

The development of the PHQ-2 was underwritten by an educational grant from Pfizer US Pharmaceuticals Inc., New York, NY. PRIME-MD is a trademark of Pfizer Inc. Copyright held by Pfizer Inc.

Address correspondence and reprint requests to: Kurt Kroenke, MD, Regenstrief Institute for Health Care, RG-6, 1050 Wishard Blvd., Indianapolis, IN 46202. E-mail: kkroenke@regenstrief.org

For a complimentary copy of PHQ materials that can be reproduced, e-mail Robert Spitzer at rls8@columbia.edu

© 2003 Lippincott Williams & Wilkins, Inc.