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PHQ-4 Calculator — PHQ-2 Depression and GAD-2 Anxiety Screen

Score the PHQ-4 ultra-brief screen for anxiety and depression: the GAD-2 and PHQ-2 subscales (positive at 3 or more) and the 0–12 total for normal, mild, moderate or severe psychological distress.

1. Feeling nervous, anxious or on edge

2. Not being able to stop or control worrying

3. Little interest or pleasure in doing things

4. Feeling down, depressed or hopeless

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How it works

Each item: not at all 0 · several days 1 · more than half the days 2 · nearly every day 3. GAD-2 = items 1 + 2; PHQ-2 = items 3 + 4; each 0–6, positive at ≥ 3. PHQ-4 total 0–12: 0–2 normal · 3–5 mild · 6–8 moderate · 9–12 severe.

The PHQ-4 (Kroenke et al., 2009) joins the two core anxiety questions of the GAD-7 (the GAD-2) with the two core depression questions of the PHQ-9 (the PHQ-2). A subscale score of 3 or more is the validated cut-off for a positive screen, which should be followed by the full GAD-7 or PHQ-9 and a clinical conversation. The total gives a quick reading of overall psychological distress and was normed in a large general-population sample (Löwe et al., 2010). The PHQ family of questionnaires is free to use.

Worked example

Over the past two weeks someone felt nervous more than half the days (2), could not stop worrying on several days (1), had little interest on several days (1) and felt down on several days (1): GAD-2 = 3 (positive), PHQ-2 = 2 (negative) and PHQ-4 = 5 / 12 — mild psychological distress, with a full GAD-7 advised.

Sources: Kroenke K et al. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics 2009 · Löwe B et al. A 4-item measure of depression and anxiety: validation and standardization of the PHQ-4 in the general population. J Affect Disord 2010

Frequently asked questions

What PHQ-2 score is positive?

A PHQ-2 score of 3 or more out of 6 is a positive depression screen. It does not diagnose depression; the next step is the full PHQ-9 and a clinical assessment.

What GAD-2 score is positive?

A GAD-2 score of 3 or more is a positive anxiety screen and should be followed by the full GAD-7. The GAD-2 also picks up panic, social anxiety and post-traumatic stress reasonably well.

What does the PHQ-4 total mean?

0–2 is normal, 3–5 mild, 6–8 moderate and 9–12 severe psychological distress. The total is useful for tracking but the two subscales are what guide the next step.

Is the PHQ-4 a diagnosis?

No. It is a short screen used in primary care, research and wellbeing checks. Only a clinician can diagnose an anxiety or depressive disorder after a full assessment.

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GAD-7 Anxiety Score Calculator

Score the seven-item Generalised Anxiety Disorder scale — minimal, mild, moderate, severe anxiety — with the GAD-2 screen and sensitivity for panic, social anxiety and PTSD.

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Geriatric Depression Scale (GDS-15) Calculator

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A screening questionnaire, not a diagnosis — only a qualified clinician can diagnose. If you or someone you care for is in crisis or having thoughts of self-harm, contact emergency services or a crisis line now.