PHQ-2: First-step depression screen. A score ≥ 3 warrants full PHQ-9 assessment. Does not replace clinical judgement.
Over the last 2 weeks, how often have you been bothered by:
1. Little interest or pleasure in doing things?
2. Feeling down, depressed, or hopeless?
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Primary care first-step screening for major depressive disorder (MDD)
Annual depression screen in all adults per USPSTF Grade B recommendation
Pre-screening before full PHQ-9 to reduce clinician burden
Screening in obstetric, oncology, cardiology, and geriatric settings where depression prevalence is elevated
Do Not Use Alone For
Confirming a diagnosis of MDD — PHQ-2 positive requires full PHQ-9
Severity assessment or monitoring treatment response
Screening for dysthymia, bipolar disorder, or anxiety disorders
Section 2
Formula & Logic
Scoring
Sum of two items, each scored 0 (Not at all) to 3 (Nearly every day)
Total range: 0–6
Positive screen threshold: ≥ 3
Items
Item 1: Little interest or pleasure in doing things (anhedonia)
Item 2: Feeling down, depressed, or hopeless (dysphoria)
Section 3
Pearls/Pitfalls
Performance Characteristics
Threshold
Sensitivity
Specificity
≥ 2
~83%
~78%
≥ 3 (recommended)
~79%
~86%
Gotchas
A score of 0 does NOT rule out depression in high-risk groups (e.g., masked depression in older adults)
PHQ-2 does not assess suicidal ideation — always ask directly if clinical concern exists
PHQ-2 items are also the first 2 items of PHQ-9; a positive PHQ-2 seamlessly transitions to PHQ-9 completion
Section 4
Next Steps
Action by Score
Score
Action
0–2
Negative screen. Rescreen annually or with clinical change.
3–6
Positive screen. Complete full PHQ-9 in same encounter.
Section 5
Literature
Development
Derived by Kroenke, Spitzer, and Williams (2003) from the Patient Health Questionnaire as a rapid first-step depression screen. Validated against a reference standard of structured psychiatric interview (SCID) in large primary care populations.
