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Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
Open accessAbstract
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.
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“The PHQ-2 score was used to estimate the severity of depression, which assessed the frequency of depressed mood and anhedonia over the past two weeks [22].”
From Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study (2023) · cites this paper as [22]
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In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measured
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Cited by
Sorted by citations
Collaborative care for patients with depression and chronic illnesses
Katon, W. J., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., Peterson, D., Rutter, C. M., McGregor, M., & McCulloch, D. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1003955 · Cited by 1,697
Manea, L., Gilbody, S., & McMillan, D. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2014.09.009 · Cited by 795
“Of the 27 studies, 13 [20,24,26,27,29–31,33,34,39,41,44,45] reported diagnostic properties of the PHQ-9 using both the algorithm and summed-item scoring method at the standard cut-off point of ≥10.”
BackgroundMethodInfluentialAlsoufi, A., Alsuyihili, A., Msherghi, A. A. A., Elhadi, A., Atiyah, H., Ashini, A., Ashwieb, A., Ghula, M., Hasan, H. B., Abudabuos, S., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0242905 · Cited by 749
“A score of 3 indicates high sensitivity in the depressed individual [16].”
BackgroundAndersen, B. L., DeRubeis, R. J., Berman, B. S., Gruman, J., Champion, V. L., Massie, M. J., Holland, J. C., Partridge, A. H., Bak, K., Somerfield, M. R., et al. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2013.52.4611 · Cited by 735
“For individuals who endorse either item (or both) as occurring for more than half of the time or nearly every day within the last 2 weeks (ie, a score of 2), a third step is suggested in which the patient completes the remaining items of the PHQ-9.(11,12) It is estimated that 25% to 30% of patients would need to compl…”
BackgroundBarzilay, R., Moore, T. M., Greenberg, D. M., DiDomenico, G. E., Brown, L. A., White, L. K., Gur, R. C., & Gur, R. E. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-00982-4 · Cited by 634
Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa
Gelaye, B., Williams, M. A., Lemma, S., Deyessa, N., Bahretibeb, Y., Shibre, T., Wondimagegn, D., Lemenhe, A., Fann, J. R., Stoep, A. V., et al. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.07.015 · Cited by 548
“Our findings are consistent with reports from community based and hospital based studies conducted globally (Adewuya et al., 2006; Arroll et al. 2010; Fann et al., 2005; Huang et al., 2006; Kalpakjian et al., 2009; Kroenke et al., 2001b; Kroenke and Spitzer, 2012; Lotrakul et al., 2008; Monahan et al., 2009; van Steen…”
ResultMitchell, K. R., Mercer, C. H., Ploubidis, G. B., Jones, K. G., Datta, J., Field, N. M., Copas, A. J., Tanton, C., Erens, B., Sonnenberg, P., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)62366-1 · Cited by 556
McCarron, R. M., Shapiro, B. B., Rawles, J., & Luo, J. S. (2021) · Annals of Internal Medicine · doi:10.7326/aitc202105180 · Cited by 511
Depression in the Primary Care Setting
Park, L. T., & Zarate, C. A. (2019) · New England Journal of Medicine · doi:10.1056/nejmcp1712493 · Cited by 504
Zhang, Y., Liang, W., Zuo-ming, C., Zhang, H., Zhang, J.-H., Weng, X., Yang, S.-C., Zhang, L., Shen, L.-J., & Zhang, Y. (2013) · Asia-Pacific Psychiatry · doi:10.1111/appy.12103 · Cited by 456
“Consistent with the previous studies (Kroenke et al., 2001, 2003; Arroll et al., 2010), this study demonstrated that PHQ-9 and its subscale, PHQ-2, are reliable and valid screening tools of depression among Chinese college students.”
ResultSantos, I. S., Tavares, B. F., Munhoz, T. N., Almeida, L. S. P. D., Silva, N. T. B. D., Tams, B. D., Patella, A. M., & Matijasevich, A. (2013) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2013001200006 · Cited by 415
Staples, L. G., Dear, B. F., Gandy, M., Fogliati, V., Fogliati, R., Karin, E., Nielssen, O., & Titov, N. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.11.003 · Cited by 405
“The finding that online administration of these short-form questionnaires can identify adults with symptoms of depression and/or anxiety replicates findings using data from patients seen in face-to-face treatment [7,10,11,13,20,22,27].”
BackgroundMoriarty, A. S., Gilbody, S., McMillan, D., & Manea, L. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.06.012 · Cited by 372
“Of the 36 samples, half (18 studies) were conducted in countries speaking predominantly English [6,14–30].”
BackgroundAiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., US Clinician Wellbeing Study Consortium, Cleary, M., Ley, C., et al. (2023) · JAMA Health Forum · doi:10.1001/jamahealthforum.2023.1809 · Cited by 371
Screening and Management of Depression in Patients With Cardiovascular Disease
Jha, M. K., Qamar, A., Vaduganathan, M., Charney, D. S., & Murrough, J. W. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.01.041 · Cited by 389
“A separate validation sample reported sensitivity and specificity of 74% and 91% respectively for PHQ-9 ≥10 threshold (75).”
Childhood adversity and adult depression: The protective role of psychological resilience
Poole, J. C., Dobson, K. S., & Pusch, D. (2017) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2016.12.012 · Cited by 407
“Although prevalence rates of MDD among Canadian primary care patients have not been reported, these rates were consistent with those reported among primary are samples in the United States and New Zealand (range from 6.6% to 8.6%; Arroll et al., 2010; Kessler et al., 2003).”
ResultInfluentialSantos, I. S., Tavares, B. F., Munhoz, T. N., de Almeida, L. S. P., da Silva, N. T. B., Tams, B. D., Patella, A. M., & Matijasevich, A. (2013) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · Cited by 367
Treatment of Adult Depression in the United States
Olfson, M., Blanco, C., & Marcus, S. C. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.5057 · Cited by 352
IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety
Mohr, D. C., Tomasino, K. N., Lattie, E. G., Palac, H. L., Kwasny, M. J., Weingardt, K., Karr, C. J., Kaiser, S. M., Rossom, R. C., Bardsley, L. R., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6645 · Cited by 301
“Furthermore, these measures are widely used in primary care settings and useful for identifying and monitoring depression and anxiety in clinical and general populations [35-37].”
BackgroundMitchell, A. J., Yadegarfar, M., Gill, J., & Stubbs, B. (2016) · BJPsych Open · doi:10.1192/bjpo.bp.115.001685 · Cited by 354
Glasgow, R. E., & Riley, W. T. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2013.03.010 · Cited by 318
Kotwal, A., Holt‐Lunstad, J., Newmark, R. L., Cenzer, I. S., Smith, A. K., Covinsky, K. E., Escueta, D. P., Lee, J. M., & Perissinotto, C. M. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16865 · Cited by 358
“Depression was measured using the Patient Health Questionnaire-2 (PHQ2) and asking if these feelings changed due to coronavirus (“worse,” “same,” or “better”).(22) Finally, we provided an opportunity for participants to share open-ended thoughts or comments about the coronavirus pandemic; 77% participated (n = 115).”
MethodRacial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic
Thomeer, M. B., Moody, M. D., & Yahirun, J. (2023) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01284-9 · Cited by 348
Frailty for Perioperative Clinicians: A Narrative Review
McIsaac, D. I., Macdonald, D. B., & Aucoin, S. D. (2020) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000004602 · Cited by 314
Firew, T., Sano, E. D., Lee, J. W., Flores, S., Lang, K. J., Salman, K., Greene, M. C., & Chang, B. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-042752 · Cited by 302
Sanghera, J., Pattani, N., Hashmi, Y., Varley, K. F., Cheruvu, M. S., Bradley, A., & Burke, J. R. (2020) · Journal of Occupational Health · doi:10.1002/1348-9585.12175 · Cited by 274
Shin, C., Lee, S., Han, K., Yoon, H.-K., & Han, C. (2019) · Psychiatry Investigation · doi:10.30773/pi.2019.02.01 · Cited by 265
Arrieta, J., Aguerrebere, M., Raviola, G. J., Flores, H., Elliott, P. F., Espinosa, A., Reyes, A., Ortiz‐Panozo, E., Rodriguez-Gutierrez, E. G., Mukherjee, J. S., et al. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22390 · Cited by 261
“The sensitivity and specificity of the PHQ-2 in this study population were similar to previous studies in the literature from primary care populations (Arroll et al., 2010; Kroenke et al., 2003; Richardson et al., 2010; Zuithoff et al., 2010).”
BackgroundResultDomain Management Approach to Heart Failure in the Geriatric Patient
Gorodeski, E. Z., Goyal, P., Hummel, S. L., Krishnaswami, A., Goodlin, S. J., Hart, L. L., Forman, D. E., WENGER, N. K., Kirkpatrick, J. N., & Alexander, K. P. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.02.059 · Cited by 266
“Asking the first 2 questions of the PHQ (PHQ-2) offers a convenient screen for depressive symptoms, and the negative predictive value is 99% for those who answer no to both questions (70).”
BackgroundIdentifying depression with the PHQ-2: A diagnostic meta-analysis
Manea, L., Gilbody, S. M., Hewitt, C. E., North, A., Plummer, F., Richardson, R., Thombs, B. D., Williams, B., & McMillan, D. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.06.003 · Cited by 273
Choi, K. W., Stein, M. B., Nishimi, K. M., Ge, T., Coleman, J. R. I., Chen, C., Ratanatharathorn, A. D., Zheutlin, A. B., Dunn, E. C., Breen, G. D., et al. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.19111158 · Cited by 241
“Participants who endorsed depressed mood and/or anhedonia (for details, see the Supplementary Methods in the online supplement) for more than half the days in the past 2 weeks at baseline (N=5,416) were considered to have elevated depressive symptoms (21) and were”
BackgroundWijma, A. J., van Wilgen, C. P., Meeus, M., & Nijs, J. (2016) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2016.1194651 · Cited by 243
“(Arroll et al, 2010).”
MethodHertz‐Palmor, N., Moore, T. M., Gothelf, D., DiDomenico, G. E., Dekel, I., Greenberg, D. M., Brown, L. A., Matalon, N., Visoki, E., White, L. K., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.04.054 · Cited by 226
“Of them, 2904 people opted in to complete GAD-7 and PHQ-2, and were included in this study.”
InfluentialZuithoff, N. P., Vergouwe, Y., King, M., Nazareth, I., van Wezep, M. J., Moons, K. G., & Geerlings, M. I. (2010) · BMC Family Practice · doi:10.1186/1471-2296-11-98 · Cited by 218
“Furthermore, very few studies validated the accuracy of the PHQ-2[10,12,16,17].”
BackgroundResultDevelopment and validation of the 25‐item Hikikomori Questionnaire (HQ‐25)
Teo, A. R., Chen, J. I., Kubo, H., Katsuki, R., Sato‐Kasai, M., Shimokawa, N., Hayakawa, K., Umene‐Nakano, W., Aikens, J. E., Kanba, S., et al. (2018) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12691 · Cited by 209
“9) considered excellent,(23) and sensitivity and PPV, though not specificity, are comparable to common cut-off scores on the 9-item Patient Health Questionnaire to screen for major depression.(24,25) The sample used to develop this scale, predominantly psychiatric patients in Japan, is relatively consistent with the i…”
BackgroundKoo, J. Y. M., Marangell, L. B., Nakamura, M., Armstrong, A. W., Jeon, C., Bhutani, T., & Wu, J. J. (2017) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.14460 · Cited by 214
Ulmer, C. S., Edinger, J. D., & Calhoun, P. S. (2011) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.28042 · Cited by 207
New Roles for Pharmacists in Community Mental Health Care: A Narrative Review
Rubio-Valera, M., Chen, T. F., & O’Reilly, C. L. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph111010967 · Cited by 204
“validity, feasibility and practicality, and a number of depression screening tools have shown to be reliable and valid in primary care settings such as the Patient Health Questionnaire (PHQ) or the WHO-5 Wellbeing Index [31–33].”
MethodThe Disproportionate Burden of the COVID-19 Pandemic Among Pregnant Black Women
Gur, R. E., White, L. K., Waller, R. E., Barzilay, R., Moore, T. M., Kornfield, S. L., Njoroge, W., Duncan, A. F., Chaiyachati, B. H., Parish‐Morris, J., et al. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113475 · Cited by 205
A Mixed-Methods Pilot Study of Perinatal Risk and Resilience During COVID-19
Farewell, C. V., Jewell, J. S., Walls, J., & Leiferman, J. A. (2020) · Journal of Primary Care & Community Health · doi:10.1177/2150132720944074 · Cited by 202
Mulvaney‐Day, N., Marshall, T., Piscopo, K. D., Korsen, N., Lynch, S. E., Karnell, L. H., Moran, G. E., Daniels, A. S., & Ghose, S. S. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4181-0 · Cited by 201
Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention.
Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2016) · American Psychological Association eBooks · doi:10.1037/0000017-000 · Cited by 193
Unintentional weight loss in older adults
Gaddey, H. L., & Holder, K. K. (2011) · Canadian Medical Association Journal · doi:10.1503/cmaj.111-2047 · Cited by 189
Nelson, B. W., Pettitt, A., Flannery, J. E., & Allen, N. B. (2020) · PLOS ONE · doi:10.1371/journal.pone.0241990 · Cited by 175
“The PHQ-2 consists of the first two questions of the PHQ-9 and has been shown to be a valid measure of depressive symptoms [26, 31, 32] with a cut-off score � 3 for identifying likely Major Depressive Disorder with a sensitivity value of 0.”
MethodSelf-Rated Health and Long-Term Prognosis of Depression
Ambresin, G., Chondros, P., Dowrick, C. F., Herrman, H., & Gunn, J. M. (2014) · The Annals of Family Medicine · doi:10.1370/afm.1562 · Cited by 195
Self-citationField, N. M., Mercer, C. H., Sonnenberg, P., Tanton, C., Clifton, S., Mitchell, K. R., Erens, B., Macdowall, W. G., Wu, F. C. W., Datta, J., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)62222-9 · Cited by 192
Hong, S., Ai, M., Xu, X., Wang, W., Chen, J., Zhang, Q., Wang, L., & Kuang, L. (2020) · Nursing Outlook · doi:10.1016/j.outlook.2020.07.007 · Cited by 185
Effects of COVID‐19 lockdown on eating disorders and obesity: A systematic review and meta‐analysis
Sideli, L., Coco, G. L., Bonfanti, R. C., Borsarini, B., Fortunato, L., Sechi, C., & Micali, N. (2021) · European Eating Disorders Review · doi:10.1002/erv.2861 · Cited by 174
PHQ-9 and PHQ-2 for Screening Depression in Chinese Rural Elderly
Liu, Z.-W., Yu, Y., Hu, M., Liu, H., Zhou, L., & Xiao, S. (2016) · PLoS ONE · doi:10.1371/journal.pone.0151042 · Cited by 166
“For PHQ-2, the score of 3 was recommended as the cutoff for screening depression in most published studies [12, 20, 22, 23].”
MethodAssociation between Atopic Dermatitis and Depression in US Adults
Yu, S. H., & Silverberg, J. I. (2015) · Journal of Investigative Dermatology · doi:10.1038/jid.2015.337 · Cited by 163
“In NHANES, respondents were asked questions from the Patient Health Questionnaire (PHQ), a validated self-reported assessment based on the nine DSM-IV symptoms for depression (Spitzer et al., 1999; Arroll et al., 2010).”
MethodHargraves, D., White, C., Frederick, R., Cinibulk, M., Peters, M., Young, A., & Elder, N. (2017) · Public Health Reviews · doi:10.1186/s40985-017-0077-0 · Cited by 161
“For several conditions, “pre-screens” have been validated that allow for rapid, universal screening, followed by more focused full screens [26, 27].”
BackgroundPrevalence of late-life depression and gap in mental health service use across European regions
Horáčková, K., Kopeček, M., Machů, V., Kågström, A., Aarsland, D., Motlová, L. B., & Čermáková, P. (2019) · European Psychiatry · doi:10.1016/j.eurpsy.2018.12.002 · Cited by 155
Mental health consequences of sexual assault among first-year college women
Carey, K. B., Norris, A. L., Durney, S. E., Shepardson, R. L., & Carey, M. P. (2018) · Journal of American College Health · doi:10.1080/07448481.2018.1431915 · Cited by 158
Cloître, M., Hyland, P., Prins, A., & Shevlin, M. E. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1930961 · Cited by 165
“…age of 18 years or older, history of trauma exposure, positive screen for either PTSD symptoms (PC-PTSD-5; Prins et al., 2016) or depression (PHQ-2; Arroll et al., 2010), no changes to medication in the previous 6 weeks, willingness to use an online treatment format and availability for the…”
BackgroundWicke, F. S., Krakau, L., Löwe, B., Beutel, M. E., & Brähler, E. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.06.054 · Cited by 145
Redgrave, J. N. E., Moore, L., Oyekunle, T., Ebrahim, M., Falidas, K., Snowdon, N., Ali, A., & Majid, A. (2018) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2018.02.056 · Cited by 141
“The participants also completed the following self-report measures: Modified Rankin Score (mRS), 17 Barthel Index, 18 Stroke Impact Scale (SIS), 19 Motor Activity Log (to measure use of the impaired limb in a variety of activities of daily living such as putting on shoes, drying hands, wiping a kitchen counter, using…”
Estimating the Prevalence of Sexual Function Problems: The Impact of Morbidity Criteria
Mitchell, K. R., Jones, K. G., Wellings, K., Johnson, A. M., Graham, C. A., Datta, J., Copas, A. J., Bancroft, J., Sonnenberg, P., Macdowall, W. G., et al. (2015) · The Journal of Sex Research · doi:10.1080/00224499.2015.1089214 · Cited by 139
“aAOR = age-Adjusted Odds Ratio; PHQ-2 = Patient Health Questionnaire-2 Unweighted, weighted denominators Defined as anyone having sex with you against your will after the age of 13 years Two screening questions (scored 0–3 per question; defined here by a total score of 3 or more) assessed depressive symptoms (PHQ-2; A…”
BackgroundMercer, C. H., Prah, P., Field, N. M., Tanton, C., Macdowall, W. G., Clifton, S., Hughes, G., Nardone, A., Wellings, K., Johnson, A. M., et al. (2016) · BMC Public Health · doi:10.1186/s12889-016-3149-z · Cited by 138
“Note that MSM who identify as gay are a subset of all MSM aUnweighted, weighted denominators defined as participants who reported at least one sexual partner in the 5 years prior to interview bMSM who identified as gay in Natsal-3 are a subset of all MSM cDefined as usual alcohol consumption greater than recommended l…”
BackgroundMethodInfluentialWeiner, L., Berna, F. S., Nourry, N., Séverac, F., Vidailhet, P., & Mengin, A. C. (2020) · Trials · doi:10.1186/s13063-020-04772-7 · Cited by 143
“The Patient Health Questionnaire – 2 items version (PHQ-2) [34] will be applied to screen for depression.”
Public Health Workforce Burnout in the COVID-19 Response in the U.S.
Stone, K. W., Kintziger, K. W., Jagger, M. A., & Horney, J. A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18084369 · Cited by 138
“Generalized anxiety disorder (GAD) was assessed using a previously validated 7-item (GAD-7) scale [22], and depressive disorder using the two-item Patient Health Questionnaire (PHQ-2) subscale [23].”
MethodMa, J., Rosas, L. G., Lv, N., Xiao, L., Snowden, M. B., Venditti, E. M., Lewis, M. A., Goldhaber-Fiebert, J. D., & Lavori, P. W. (2019) · JAMA · doi:10.1001/jama.2019.0557 · Cited by 133
Evaluation of a Preoperative Optimization Protocol for Primary Hip and Knee Arthroplasty Patients
Bernstein, D. N., Liu, T. C., Winegar, A. L., Jackson, L. W., Darnutzer, J. L., Wulf, K. M., Schlitt, J. T., Sardan, M. A., & Bozic, K. J. (2018) · The Journal of Arthroplasty · doi:10.1016/j.arth.2018.08.018 · Cited by 132
Prevalence of DSM-IV Major Depression Among U.S. Military Personnel: Meta-Analysis and Simulation
Gadermann, A., Engel, C. C., Naifeh, J. A., Nock, M. K., Petukhova, M. V., Santiago, P. N., Wu, B., Zaslavsky, A. M., & Kessler, R. C. (2012) · Military Medicine · doi:10.7205/milmed-d-12-00103 · Cited by 131
Context-aware Deep Learning for Multi-modal Depression Detection
Lam, G., Dongyan, H., & Lin, W. (2019) · IEEE International Conference on Acoustics Speech and Signal Processing · doi:10.1109/icassp.2019.8683027 · Cited by 129
“GPs use the Patient Health Questionnaire (PHQ), a standard method for diagnosis of depression [2].”
MethodThe Turker Blues: Hidden Factors Behind Increased Depression Rates Among Amazon’s Mechanical Turkers
Ophir, Y., Sisso, I., Asterhan, C. S. C., Tikochinski, R., & Reichart, R. (2019) · Clinical Psychological Science · doi:10.1177/2167702619865973 · Cited by 124
“(2018) administered a two-item screening tool for depression (Patient Health Questionnaire–2, or PHQ-2; Arroll et al., 2010) to a sample of 591 young MTurk workers (age < 50).”
MethodThe Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease
Rahi, M. S., Thilagar, B., Balaji, S., Prabhakaran, S. Y., Mudgal, M., Rajoo, S., Yella, P. R., Satija, P., Zagorulko, A., & Gunasekaran, K. (2023) · Advances in respiratory medicine · doi:10.3390/arm91020011 · Cited by 137
“• Patient Health Questionnaire-2, 9 (PHQ -2 and 9): widely used with 2 and 9 item versions [53].”
MethodDepression in primary care: part 1—screening and diagnosis
Ferenchick, E. K., Ramanuj, P., & Pincus, H. A. (2019) · BMJ · doi:10.1136/bmj.l794 · Cited by 131
Jani, B., Nicholl, B. I., McQueenie, R., Connelly, D. T., Hanlon, P., Gallacher, K., Lee, D., & Mair, F. S. (2017) · EP Europace · doi:10.1093/europace/eux322 · Cited by 118
“Presence of depressive symptoms was defined based on the results of high Patient Health Questionnaire (PHQ-2), a score of 2 or more was used as a cut-off.(13) Multimorbidity was classified on the basis of count into three categories: presence of no other LTCs, presence of 1–3 LTCs, and presence of 4 or more LTCs.”
MethodPaternal depressive symptoms and child behavioral or emotional problems in the United States
Weitzman, M., Rosenthal, D. G., & Liu, Y.-H. (2011) · Pediatrics · doi:10.1542/peds.2010-3034 · Cited by 116
Wang, Y., Lopez, J. M. S., Bolge, S. C., Zhu, V. J., & Stang, P. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0800-2 · Cited by 117
“Used most often in primary care settings, the PHQ-9 has been shown to be a reliable and valid tool for screening depression [37], including in the elderly [38], and has been applied in studies of diabetes [39].”
MethodHaddad, M., Walters, P., Phillips, R., Tsakok, J., Williams, P., Mann, A., & Tylee, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0078493 · Cited by 109
“Interestingly, this categorisation of the PHQ-9 score is not adopted by the McArthur Foundation [42] initiative on depression and primary care (which notes PHQ-9 scores of 10-14 as indicative mild depression), nor was it used in a recent large-scale evaluation of the PHQ-9 in primary care [43].”
MethodLee, H. Y., Kim, M. S., Kim, O., Lee, I.-H., & Kim, H.-K. (2016) · Journal of Nursing Management · doi:10.1111/jonm.12298 · Cited by 110
“The Cronbach’s alpha reliability estimate in the present study was 0.90, which is similar to the Cronbach’s alpha reliability estimate of 0.87 in the original PHQ-9 study (Arroll et al. 2010).”
ResultInfluentialDo Patients Want Help Addressing Social Risks?
Marchis, E. H. D., Alderwick, H., & Gottlieb, L. M. (2020) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2020.02.190309 · Cited by 109
“For instance, in depression screening, answering affirmatively to either question in the 2item Patient Health Questionnaire (PHQ) signals that a patient is at risk for depression; it is not used to diagnose depression.(36,37) In social risk screening, positive results are often conflated with diagnosis of Table 2.”
BackgroundXiong, N., Fritzsche, K., Wei, J., Hong, X., Leonhart, R., Zhao, X., Zhang, L., Zhu, L., Tian, G., Nolte, S., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.042 · Cited by 108
“The 2-item Patient Health Questionnaire (PHQ-2), containing the first 2 items of the PHQ-9, has also performed well as a depression screening tool with comparable performance to the PHQ-9 (Chen et al., 2010; Liu et al., 2011; Arroll et al., 2010).”
MethodAlvarez-Jimenez, M., Rice, S., D'Alfonso, S., Leicester, S., Bendall, S., Pryor, I., Russon, P., McEnery, C., Santesteban-Echarri, O., Da Costa, G., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/17155 · Cited by 106
Pence, B. W., Gaynes, B. N., Atashili, J., O’Donnell, J. K., Tayong, G., Kats, D., Whetten, R., Whetten, K., NJAMNSHI, A. K., & Ndumbe, P. M. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.05.056 · Cited by 105
“Our approach, however, was consistent with (Arroll et al., 2010) or more stringent than (Zuithoff et al.”
MethodResultWhich PHQ-9 Items Can Effectively Screen for Suicide? Machine Learning Approaches
Kim, S., Lee, H.-K., & Lee, K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073339 · Cited by 99
“This tool has been verified for screening for depression in the general population and various groups outside the primary care environment [11,12].”
MethodTouchscreen typing pattern analysis for remote detection of the depressive tendency
Mastoras, R.-E., Iakovakis, D., Hadjidimitriou, S., Charisis, V. S., Kassie, S. A., Alsaadi, T. M., Khandoker, A. H., & Hadjileontiadis, L. J. (2019) · Scientific Reports · doi:10.1038/s41598-019-50002-9 · Cited by 99
Pati, S., Swain, S., Metsemakers, J. F. M., Knottnerus, J. A., & van den Akker, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0183966 · Cited by 101
Chen, S., Fang, Y., Chiu, H., Fan, H., Jin, T., & Conwell, Y. (2013) · Asia-Pacific Psychiatry · doi:10.1111/appy.12063 · Cited by 100
“The PHQ-9 has been used in a few studies for screening depression in primary care settings (Pinto-Meza et al., 2005; Chen et al., 2006, 2011; Arroll et al., 2010).”
MethodKang, E., Lee, S. Y., Kim, M. S., Jung, H., Kim, K. H., Kim, K., Park, H. Y., Lee, Y. J., Cho, B., & Sohn, J. H. (2021) · Journal of Korean Medical Science · doi:10.3346/jkms.2021.36.e33 · Cited by 95
Wang, Q., Fang, Y., Huang, H., Lv, W., Wang, X., Yang, T., Yuan, J., Gao, Y., Qian, R., & Zhang, Y. (2021) · Journal of Nursing Management · doi:10.1111/jonm.13265 · Cited by 98
“The Cronbach's α of 0.92 was shown in our study, which was similar to the alpha coefficient of 0.87 in the original Chinese study (Arroll et al., 2010).”
ResultInfluentialPalermo, T. M., de la Vega, R., Murray, C. B., Law, E. F., & Zhou, C. (2020) · Pain · doi:10.1097/j.pain.0000000000001994 · Cited by 94
“Youth also completed 2 items from the Adolescent Sleep Wake Scale(11) to screen for (1) difficulties with falling asleep and (2) staying asleep, with endorsement of “quite often” or greater for either symptom triggering release of a supplementary module targeting insomnia symptoms.”
BackgroundMethodInfluentialProspective Comparison of Preoperative Predictive Performance Between 3 Leading Frailty Instruments
McIsaac, D. I., Harris, E. P., Hladkowicz, E., Moloo, H., Lalu, M. M., Bryson, G. L., Huang, A. R., Joanisse, J. A., Hamilton, G. M., Forster, A. J., et al. (2019) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000004475 · Cited by 94
Miltz, A. R., Lampe, F. C., Bacchus, L., McCormack, S., Dunn, D. T., White, E., Rodger, A., Phillips, A. N., Sherr, L., Clarke, A. E., et al. (2019) · BMC Public Health · doi:10.1186/s12889-019-6757-6 · Cited by 98
Anxiety and Depression in Chronic Obstructive Pulmonary Disease: Recognition and Management
Yohannes, A. M., Kaplan, A. G., & Hanania, N. A. (2018) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.85.s1.03 · Cited by 95
“6,67,68 In a study investigating tools used by family physicians in England to assess depression, over 75% used PHQ-9.”
BackgroundMethodRahman, M. A., Dhira, T. A., Sarker, A. R., & Mehareen, J. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269634 · Cited by 113
Contractor, A. A., Elhai, J. D., Fine, T. H., Tamburrino, M., Cohen, G. H., Shirley, E. R., Chan, P. K., Liberzon, I., Galea, S., & Calabrese, J. R. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.05.014 · Cited by 94
Cassiani-Miranda, C. A., Cuadros-Cruz, A. K., Torres-Pinzón, H., Scoppetta, O., Pinzón-Tarrazona, J. H., López-Fuentes, W. Y., Paez, A., Cabanzo-Arenas, D. F., Ribero-Marulanda, S., & Llanes-Amaya, E. R. (2021) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2019.09.001 · Cited by 89
Vindel, A. C., Muñoz‐Navarro, R., Medrano, L. A., Ruiz‐Rodríguez, P., González‐Blanch, C., Gómez-Castillo, M. D., Capafons, A., Chacón, F., & Santolaya, F. J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.01.030 · Cited by 95
Korff, M. V., Katon, W. J., Lin, E. H. B., Ciechanowski, P. S., Peterson, D., Ludman, E. J., Young, B. A., & Rutter, C. M. (2011) · BMJ · doi:10.1136/bmj.d6612 · Cited by 87
Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care
Cook, B. L., Zuvekas, S. H., Chen, J., Progovac, A. M., & Lincoln, A. K. (2016) · Medical Care Research and Review · doi:10.1177/1077558716646898 · Cited by 93
“PHQ-2 scores ≥2 have strong sensitivity (86%) and specificity (78%) to a diagnosis of major depressive disorder (Arroll et al., 2010).”
Caring for LGBTQ patients: Methods for improving physician cultural competence
Klein, E. W., & Nakhai, M. (2016) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217416659268 · Cited by 87
“Participants are taught to use the PHQ 2 and PHQ 9 for depression screening in our adult patients.(9) Referrals to mental health professionals who have experience with LGBTQ patients are also recommended.”
MethodGryczynski, J., McNeely, J., Wu, L.-T. T., Subramaniam, G., Svikis, D. S., Cathers, L. A., Sharma, G., King, J., Jelstrom, E., Nordeck, C. D., et al. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4079-x · Cited by 86
“, analogous to using the PHQ-2 followed by PHQ-9 for depression screening).(23) The TAPS tool, using this two-part approach, was recently validated in primary care by the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN0059).”
MethodPostpartum Depression: Current Status and Possible Identification Using Biomarkers
Yu, Y., Liang, H.-F., Chen, J., Li, Z., Han, Y., Chen, J.-X., & Li, J.-C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.620371 · Cited by 96
“PHQ-2 contains the first two items of the PHQ-9.”
MethodClark, C. J., Lewis-Dmello, A., Anders, D., Parsons, A., Nguyen-Feng, V., Henn, L., & Emerson, D. (2014) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2014.04.003 · Cited by 85
Weilenmann, S., Ernst, J., Petry, H., Pfaltz, M. C., Sazpinar, O., Gehrke, S., Paolercio, F., von Känel, R., & Spiller, T. R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.594340 · Cited by 85
“Both questionnaires are validated and frequently used instruments to assess the selfreported symptom severity of generalized anxiety and depression (18, 19).”
Sung, S. C., Low, C. C. H., Fung, D. S. S., & Chan, Y. H. (2013) · Asia-Pacific Psychiatry · doi:10.1111/appy.12101 · Cited by 82
“Scores of 5, 10, 15, and 20 represent mild, moderate, moderately severe, and severe depression, respectively (Arroll et al., 2010).”
BackgroundMethodInfluentialChang, B., Gitlin, D., & Patel, R. B. (2011) · PubMed · Cited by 82
The First Australian National Trans Mental Health Study: Summary of Results
Hyde, Z., Doherty, M. B., Tilley, M. R., McCaul, K. A., Rooney, R. M., & Jancey, J. M. (2013) · eSpace (Curtin University) · Cited by 82
Metadata
- Authors
- Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., Falloon, K., & Hatcher, S.
- Affiliations
- University of Auckland (NZ)
- 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
- 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
- diamond
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › 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
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