An ultra-brief screening scale for anxiety and depression: the PHQ-4

Psychosomatics. Nov-Dec 2009;50(6):613-21. doi: 10.1176/appi.psy.50.6.613.

Abstract

Background: The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability.

Objective: When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both.

Method: Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States.

Results: Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression.

Conclusion: The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / diagnosis*
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology
  • Comorbidity
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Interview, Psychological / methods
  • Male
  • Mass Screening / methods*
  • Mass Screening / statistics & numerical data
  • Mental Health / statistics & numerical data*
  • Middle Aged
  • Prevalence
  • Quality of Life / psychology
  • Reproducibility of Results
  • Self Disclosure
  • Surveys and Questionnaires*
  • United States / epidemiology
  • Young Adult