PHQ-2
Two-item depression screen (mood and anhedonia)
Sources last checked: 2026-10-13
PHQ-2
Two-item depression screen (mood and anhedonia)
A screen, not a diagnosis. It does not ask about suicidal thoughts, so a negative or positive PHQ-2 says nothing about suicide risk.
Interpretation
| 0–2 — negative screen | Below the recommended cut-off. A score of 2 has higher sensitivity but more false positives. |
|---|---|
| 3–6 — positive screen | ≥ 3: 83 % sensitivity, 92 % specificity for major depression (Kroenke 2003). A positive PHQ-2 is a screen only; in the two-step approach evaluated by Levis 2020 it is followed by the full PHQ-9. |
What is the PHQ-2?
The PHQ-2 consists of the first two items of the PHQ-9: depressed mood and loss of interest or pleasure over the last two weeks, each scored 0–3. Kroenke and colleagues validated it in 2003 in the same 6,000-patient cohort as the PHQ-9; a score of 3 or more had 83 % sensitivity and 92 % specificity for major depression.
When to use it
- Quick first-step depression screening in busy clinics
- As a gate to the full PHQ-9 in a two-step screening pathway
- Population or questionnaire-based screening where length matters
When not to use it
- To grade severity or monitor treatment — use the PHQ-9
- As a diagnosis, or as a substitute for asking about suicidality
How it is calculated
| Criterion | Points |
|---|---|
| 1. Little interest or pleasure in doing things | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
| 2. Feeling down, depressed, or hopeless | |
| Not at all | 0 |
| Several days | 1 |
| More than half the days | 2 |
| Nearly every day | 3 |
Clinical pearls and limitations
- A screen, not a diagnosis. It does not ask about suicidal thoughts, so a negative or positive PHQ-2 says nothing about suicide risk.
- A large IPD meta-analysis (2020) found sensitivity 0.72 and specificity 0.85 at ≥ 3; ≥ 2 raises sensitivity to 0.91 at the cost of specificity.
- Combining PHQ-2 ≥ 2 with PHQ-9 ≥ 10 performs similarly to the PHQ-9 alone with fewer items for most patients.
- The yes/no “two-question test” recommended in the NVL is a different format — do not mix the scoring.
Frequently asked questions
What is a positive PHQ-2?
A total of 3 or more out of 6. Some pathways use 2 or more to increase sensitivity.
What follows a positive PHQ-2?
In a two-step pathway the full PHQ-9 follows, together with a clinical assessment that includes a direct question about suicidal thoughts.
Is the PHQ-2 the same as the Whooley questions?
They ask about the same two symptoms, but the Whooley questions are answered yes/no, while the PHQ-2 rates frequency from 0 to 3.
Evidence and guidelines
- Primary source: Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003;41(11):1284-1292.
- Levis B et al. Accuracy of the PHQ-2 alone and in combination with the PHQ-9 for screening to detect major depression: IPD meta-analysis. JAMA 2020;323(22):2290-2300.
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