An Ultra-brief Screening Scale for Anxiety and Depression: the PHQ-4

Overview

Journal Psychosomatics

Publisher Elsevier

Specialty Psychiatry

Date 2009 Dec 10

PMID 19996233

Citations 1636

Authors

Kurt Kroenke

Robert L Spitzer

Janet B W Williams

Bernd Lowe

Affiliations

Soon will be listed here.

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.

Citing Articles

Symptoms of Mental Health Conditions and Their Predictors Among U.S. Adults During the First Year of the COVID-19 Pandemic.

Boyle J, Dayton J, ZuWallack R, Iachan R, Krugipudi D, Blanco C Healthcare (Basel). 2025; 13(5).

PMID: 40077082 PMC: 11898436. DOI: 10.3390/healthcare13050519.

Stigmatizing attitudes toward people with migraine by people without active migraine: results of the OVERCOME (US) study.

Shapiro R, Viktrup L, Muenzel E, Buse D, Zagar A, Ashina S BMC Neurol. 2025; 25(1):103.

PMID: 40075330 PMC: 11899170. DOI: 10.1186/s12883-025-04039-1.

Discordance between patient and physician global assessments of psoriatic arthritis activity: an observational study in 13 Arab countries.

Abbas N, Hmamouchi I, Kibbi L, Maroof A, Elzorkany B, Abdulateef N Rheumatol Int. 2025; 45(4):70.

PMID: 40072616 DOI: 10.1007/s00296-025-05819-1.

Identify predictive factors for the emergence of self-reported oropharyngeal dysphagia in older men and women populations: a retrospective cohort analysis.

Liu S, Fan L, Tian H, Wei S, Zhang S, He M Front Neurol. 2025; 16:1439579.

PMID: 40061161 PMC: 11887041. DOI: 10.3389/fneur.2025.1439579.

Dual decision-making routes for COVID-19 and influenza vaccines uptake in parents: A mixed-methods study.

Yuan J, Dong M, Ip D, So H, Liao Q Br J Health Psychol. 2025; 30(2):e12789.

PMID: 40052507 PMC: 11887008. DOI: 10.1111/bjhp.12789.