Patient Health Questionnaire-4

PHQ-4v2009DepressionOriginal wording

5 items · Time frame: Past 2 weeks

An ultra-brief screen for anxiety and depression: the two core anxiety items of the GAD-7 (GAD-2) and the two core depression items of the PHQ (PHQ-2), over the past two weeks. The OECD recommends it for population mental health alongside its well-being modules. A screening instrument, not a measure of momentary affect.

⚠ Safety note

The PHQ-4 screens for anxiety and depression. Before using it, decide how you will respond to participants whose scores indicate risk (either subscale 3 or more), and make support resources available in the app. Do not show scores or clinical interpretations to participants.

Source

Wording as in OECD (2025), Box 2.7 (population mental health extended module), p. 41.

Scoring

Score each item 0–3 and sum (0–12): 0–2 normal, 3–5 mild, 6–8 moderate, 9–12 severe. Items 1–2 (anxiety) sum to 3 or more: at risk for generalised anxiety. Items 3–4 (depression) sum to 3 or more: at risk for depression. Do not impute missing items; a subscale with a missing item is not scored. Do not report single items as prevalence rates.

Citation

Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50(6), 613–621.

doi:10.1176/appi.psy.50.6.613

License: Public domain: "No permission is required to reproduce, translate, display or distribute" (PHQ instruction manual, phqscreeners.com). Developed by Drs. Robert L. Spitzer, Janet B. W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.

Items (5)

Anxiety (GAD-2)

#2likertAnxiety (GAD-2)Past 2 weeks

Feeling nervous, anxious or on edge

0–3
  1. 0Not at all
  2. 1Several days
  3. 2More than half the days
  4. 3Nearly every day
#3likertAnxiety (GAD-2)Past 2 weeks

Not being able to stop or control worrying

0–3
  1. 0Not at all
  2. 1Several days
  3. 2More than half the days
  4. 3Nearly every day

Depression (PHQ-2)

#4likertDepression (PHQ-2)Past 2 weeks

Feeling down, depressed or hopeless

0–3
  1. 0Not at all
  2. 1Several days
  3. 2More than half the days
  4. 3Nearly every day
#5likertDepression (PHQ-2)Past 2 weeks

Little interest or pleasure in doing things

0–3
  1. 0Not at all
  2. 1Several days
  3. 2More than half the days
  4. 3Nearly every day
#1text

Over the last two weeks, how often have you been bothered by any of the following problems. When thinking about "how often", please choose from the following options: not at all; several days; more than half the days; nearly every day.

Use this scale in your own ESM/EMA study — embed it as a survey within SMAAT.

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