CoChat
Sign Up
Cited by 1,279Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessTreatment of Major Depression

Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population

Open access
Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., Falloon, K., Hatcher, S.·2010·The Annals of Family Medicine
DOI 10.1370/afm.1139PMC PMC2906530
Open this paper in CoChat — free accountOpen PDF

Abstract

PURPOSE: Although screening for unipolar depression is controversial, it is potentially an efficient way to find undetected cases and improve diagnostic acumen. Using a reference standard, we aimed to validate the 2- and 9-question Patient Health Questionnaires (PHQ-2 and PHQ-9) in primary care settings. The PHQ-2 comprises the first 2 questions of the PHQ-9. METHODS: Consecutive adult patients attending Auckland family practices completed the PHQ-9, after which they completed the Composite International Diagnostic Interview (CIDI) depression reference standard. Sensitivities and specificities for PHQ-2 and PHQ-9 were analyzed. RESULTS: There were 2,642 patients who completed both the PHQ-9 and the CIDI. Sensitivity and specificity of the PHQ-2 for diagnosing major depression were 86% and 78%, respectively, with a score of 2 or higher and 61% and 92% with a score 3 or higher; for the PHQ-9, they were 74% and 91%, respectively, with a score of 10 or higher. For the PHQ-2 a score of 2 or higher detected more cases of depression than a score of 3 or higher. For the PHQ-9 a score of 10 or higher detected more cases of major depression than the PHQ determination of major depression originally described by Spitzer et al in 1999. CONCLUSIONS: We report the largest validation study of the PHQ-2 and PHQ-9, compared with a reference standard interview, undertaken in an exclusively primary care population. The PHQ-2 score or 2 or higher had good sensitivity but poor specificity in detecting major depression. Using a PHQ-2 threshold score of 2 or higher rather than 3 or higher resulted in more depressed patients being correctly identified. A PHQ-9 score of 10 or higher appears to detect more depressed patients than the originally described PHQ-9 scoring for major depression.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1370/afm.1139

Cites

19 of 19 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The PHQ-8 has excellent internal consistency (Cronbach α=.89) and excellent test-retest reliability.

    “The PHQ-8 has excellent internal consistency (Cronbach α=.89) and excellent test-retest reliability [47].”

    From Feasibility and Preliminary Efficacy of Digital Interventions for Depressive Symptoms in Working Adults: Multiarm Randomized Controlled Trial (2023) · cites this paper as [47]

    The Introduction describes validation of the PHQ-2 and PHQ-9, and the Discussion reports their diagnostic sensitivity and specificity; page numbers are unavailable in our copy. Searches for PHQ-8, Cronbach α=.89, and test-retest reliability found no passage addressing the claimed PHQ-8 reliability results. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • The PHQ-8 has excellent internal consistency (Cronbach α of .89 in primary care settings and .88 in this study at t0) and excellent test-retest reliability.

    “The PHQ-8 has excellent internal consistency (Cronbach α of .89 in primary care settings and .88 in this study at t0) and excellent test–retest reliability [49].”

    From Feasibility and Preliminary Efficacy of Web-Based and Mobile Interventions for Common Mental Health Problems in Working Adults: Multi-Arm Randomized Pilot Trial (2022) · cites this paper as [49]

    The Introduction and Discussion describe validation of the PHQ-2 and PHQ-9 against a diagnostic interview, reporting sensitivity and specificity rather than PHQ-8 reliability. Searches for PHQ-8, Cronbach’s alpha, .89, .88, and test–retest reliability found no passage supporting the attributed claim. Page numbers were not provided in our copy. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. N Z Med J. 2003;116(1171):U379.
  2. Ministry of Health. Taking the Pulse. The 1996/97 New Zealand Health Survey. Wellington: Ministry of Health; 1999:197-202.
  3. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.

Cited by

Sorted by citations

Related

Authors
Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., Falloon, K., & Hatcher, S.
Affiliations
University of Auckland (NZ)
ORCID
Venue
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Published
2010-07-01
Volume
8
Issue
4
Pages
348-353
ISSN
  • 1544-1709 (ISSN-L)
  • 1544-1717
DOI
10.1370/afm.1139
PMC
PMC2906530
OpenAlex
W2122884679
Cited by
1,279
References
18
Citations by year
2026: 60 · 2025: 89 · 2024: 115 · 2023: 115 · 2022: 137 · 2021: 182 · 2020: 116 · 2019: 92 · 2018: 71 · 2017: 63 · 2016: 60 · 2015: 55 · 2014: 39 · 2013: 42 · 2012: 23
FWCI
34.75
Type
journal article
Language
en
Open access
Locations
  • The Annals of Family Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion, cc-by)
Funders
Health Research Council of New Zealand
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
PHQ-2, PHQ-9, Patient Health Questionnaire, major depressive disorder, depression screening, primary care, screening sensitivity and specificity, Composite International Diagnostic Interview, threshold scores, general practice
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Major Depressive Disorder, Depressive Disorder, Major, Diagnosis, Computer-Assisted, Female, Humans, Male, Mass Screening, Middle Aged, New Zealand, Physicians, Family, Predictive Value of Tests, Primary Health Care, Psychometrics, Surveys and Questionnaires, Sensitivity and Specificity, Software, Time Factors, Prevalence, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review