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Patient Health Questionnaire - 2 (PHQ-2)
Please visit this website for more information about the instrument: Patient Health Questionnaire - 2
Supplemental: Parkinson's Disease (PD)
Short Description of Instrument
The Patient Health Questionnaire - 2 (PHQ-2) is a screening tool that is specific for depression. It includes the initial two items of the PHQ-9, which assess for presence and frequency of depressed mood (feeling down or hopeless) and anhedonia (loss of interest or pleasure) over the prior two weeks.  
Comments/Special Instructions
PHQ-2 can be used alone as a screening tool for depressive disorders. Often, it is used as a first step in screening to identify patients who warrant further evaluation using the full PHQ-9. It is not intended for use as a diagnostic tool or to evaluate depression severity.
Scoring and Psychometric Properties
Scoring: 2 items are each scored on a scale of 0 to 3, resulting in a total score of 0 to 6:
0 = not at all
1 = several days
2 = more than half the days
3 = nearly every day
Psychometric Properties: Initial analyses recommended a PHQ-2 score of 3 as the optimal cutoff point for depression screening (Kroenke et al., 2003). Individual participant data meta-analysis of studies across diverse adult populations estimated accuracy of PHQ-2 scores for diagnosing major depression alone versus when used in combination with PHQ-9. For PHQ-2 with cutoff > 2, sensitivity was 0.91 and specificity was 0.67 versus a cut-off > 3 in which sensitivity was 0.72 and specificity was 0.85. For PHQ-2 scores of 2 or higher followed by PHQ-9 of 10 or greater, sensitivity was 0.82 and specificity was 0.87 as compared to use of PHQ-9 alone (with cutoff score > 10) with sensitivity of 0.86 and specificity of 0.85. However, the combination of PHQ-2 followed by PHQ-9 reduced the estimated number required to complete the full PHQ-9 by 57% (Levis B et al., 2020).
Administration: Self-administered, 1 to 3 minutes, paper & pencil or electronic form
Strengths: Aligns with the two core criteria for DSM-IV major depression. Validated depression screening tool.
Weaknesses: Does not assess suicidality, which is in item 9 of PHQ-9; Not suitable for monitoring depression severity.
Key Reference:
Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003 Nov;41(11):1284-92.
Additional References:
Levis B, Sun Y, He C, Wu Y, Krishnan A, Bhandari PM, Neupane D, Imran M, Brehaut E, Negeri Z, Fischer FH, Benedetti A, Thombs BD; Depression Screening Data (DEPRESSD) PHQ Collaboration, Che L, Levis A, Riehm K, Saadat N, Azar M, Rice D, Boruff J, Kloda L, Cuijpers P, Gilbody S, Ioannidis J, McMillan D, Patten S, Shrier I, Ziegelstein R, Moore A, Akena D, Amtmann D, Arroll B, Ayalon L, Baradaran H, Beraldi A, Bernstein C, Bhana A, Bombardier C, Buji RI, Butterworth P, Carter G, Chagas M, Chan J, Chan LF, Chibanda D, Cholera R, Clover K, Conway A, Conwell Y, Daray F, de Man-van Ginkel J, Delgadillo J, Diez-Quevedo C, Fann J, Field S, Fisher J, Fung D, Garman E, Gelaye B, Gholizadeh L, Gibson L, Goodyear-Smith F, Green E, Greeno C, Hall B, Hampel P, Hantsoo L, Haroz E, Harter M, Hegerl U, Hides L, Hobfoll S, Honikman S, Hudson M, Hyphantis T, Inagaki M, Ismail K, Jeon HJ, JettÉ N, Khamseh M, Kiely K, Kohler S, Kohrt B, Kwan Y, Lamers F, Asunción Lara M, Levin-Aspenson H, Lino V, Liu SI, Lotrakul M, Loureiro S, LÖwe B, Luitel N, Lund C, Marrie RA, Marsh L, Marx B, McGuire A, Mohd Sidik S, Munhoz T, Muramatsu K, Nakku J, Navarrete L, Osório F, Patel V, Pence B, Persoons P, Petersen I, Picardi A, Pugh S, Quinn T, Rancans E, Rathod S, Reuter K, Roch S, Rooney A, Rowe H, Santos I, Schram M, Shaaban J, Shinn E, Sidebottom A, Simning A, Spangenberg L, Stafford L, Sung S, Suzuki K, Swartz R, Tan PLL, Taylor-Rowan M, Tran T, Turner A, van der Feltz-Cornelis C, van Heyningen T, van Weert H, Wagner L, Li Wang J, White J, Winkley K, Wynter K, Yamada M, Zhi Zeng Q, Zhang Y. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis. JAMA. 2020 Jun 9;323(22):2290-2300.
Parkinson's Disease-Specific References:
Chagas MH, Crippa JA, Loureiro SR, Hallak JE, Meneses-Gaya Cd, Machado-de-Sousa JP, Rodrigues GR, Filho AS, Sanches RF, Tumas V. Validity of the PHQ-2 for the screening of major depression in Parkinson's disease: two questions and one important answer. Aging Ment Health. 2011 Sep;15(7):838-43.
Document last updated August 2022