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

774 Scopus citations


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
Issue number6
StatePublished - Jan 1 2009

ASJC Scopus subject areas

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

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