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

Kurt Kroenke, Robert L. Spitzer, Janet B.W. Williams, Bernd Löwe

Research output: Contribution to journalArticle

637 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)613-621
Number of pages9
JournalPsychosomatics
Volume50
Issue number6
DOIs
StatePublished - Jan 1 2009

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Anxiety
Depression
Depressive Disorder
Anxiety Disorders
Mental Disorders
Statistical Factor Analysis
Primary Health Care
Outpatients
Screening
Delivery of Health Care
Health
Population

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Applied Psychology
  • Psychiatry and Mental health

Cite this

An ultra-brief screening scale for anxiety and depression : The PHQ-4. / Kroenke, Kurt; Spitzer, Robert L.; Williams, Janet B.W.; Löwe, Bernd.

In: Psychosomatics, Vol. 50, No. 6, 01.01.2009, p. 613-621.

Research output: Contribution to journalArticle

Kroenke, Kurt ; Spitzer, Robert L. ; Williams, Janet B.W. ; Löwe, Bernd. / An ultra-brief screening scale for anxiety and depression : The PHQ-4. In: Psychosomatics. 2009 ; Vol. 50, No. 6. pp. 613-621.
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