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

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

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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

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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.

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Validation and Utility of a Self-report Version of PRIME-MD<SUBTITLE>The PHQ Primary Care Study</SUBTITLE>
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Prevalence and correlates of alcohol use, mental disorders, and awareness and utilization of support services among healthcare professionals in West Rand District, Gauteng, South Africa: a cross-sectional study
Magh, C. M., Fadahun, O., & Francis, J. M. (2023) · Family Practice · doi:10.1093/fampra/cmad094 · Cited by 8
“22 The generalized anxiety disorder-7 (GAD-7) tool was used to screen for generalized anxiety disorder.”
The Association Between Depression and Substance Use Among Primary Care Patients With Comorbid Medical and Behavioral Health Conditions
McGovern, M. P., Dunn, J. A., Bonnell, L. N., Leibowitz, G. S., Waddell, E. N., Rose, G. L., & Littenberg, B. (2023) · Journal of Primary Care & Community Health · doi:10.1177/21501319231200302 · Cited by 8
Association of part-time clinical work with well-being and mental health in General Internal Medicine: A survey among Swiss hospitalists
Bretagne, L., Mosimann, S., Roten, C., Perrig, M., Genné, D., Essig, M., Mancinetti, M., Méan, M., Farhoumand, P. D., Huber, L. C., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0290407 · Cited by 10
“Depressive symptoms were assessed by the 2 first items of the 9-item Patient Health Questionnaire (PHQ-2), which has been validated as a screening tool for depression [35].”
Development and validation of the mpox stigma scale (MSS) and mpox knowledge scale (MKS)
Henna Budhwani, P., Yiğit, İ., Stocks, J. B., Stoner, M. C. D., Browne, E. N., Pettifor, A. E., & Hightow‐Weidman, L. (2024) · BMC Public Health · doi:10.1186/s12889-024-19868-x · Cited by 8
“Brief scales are widely used across clinical care and the behavioral sciences, often as screeners prior to the conduct of more detailed or intensive evaluations [36, 37].”
Method
Determinants of depression and anxiety in informal waste pickers: a cross-sectional study of informal waste pickers in Hong Kong
Chan, S., Xu, H. Y., Tang, Y., Zhang, J., Kwok, K., Lam, B. Y., Tang, W.-H., & Lui, K. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02342-w · Cited by 8
“The PHQ was validated as having high sensitivity in detecting major depression [20, 21].”
The need for scientific leadership and collaboration to enhance social connection: A call to action
Holt‐Lunstad, J., Cudjoe, T., Dumitriu, D., Ellison, N. B., Kotwal, A., Pantell, M. S., Perissinotto, C. M., & Smith, M. L. (2025) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.15343 · Cited by 8
Informing Hospital Physician Well-Being Interventions in Europe and the US
Aiken, L. H., Sermeus, W., McKee, M., Busse, R., Smith, H. L., Maier, C. B., Drennan, J., Dello, S., Kohnen, D., McHugh, M. D., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.44067 · Cited by 8
Patient Care Outcomes of a Tobacco Use Registry in an Academic Family Practice
Ripley-Moffitt, C., Neutze, D., Gwynne, M. D., & Goldstein, A. O. (2015) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2015.02.140121 · Cited by 8
“Our tobacco registry form included depression screening prompts, which also were included in the other chronic disease registries.(14) We have not reported on this variable because we could not examine individual contributions from this registry.”
Method
Comprehensive care of pain
Rickert, J., Devlin, K., & Krohn, K. (2016) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217416659270 · Cited by 8
Aging and the Art of Happiness: Time Effects of A Positive Psychology Program with Older Adults
Orsega-Smith, E. M., Goodwin, S. C., Ziegler, M. L., Greenawalt, K. E., Turner, J., & Rathie, E. (2019) · OBM Geriatrics · doi:10.21926/obm.geriatr.1901029 · Cited by 8
Therapist-guided online metacognitive intervention for excessive worry: a randomized controlled trial with mediation analysis
Wahlund, T., Hesser, H., Perrin, S. G., Johansson, S., Huhn, V., Sörhus, S., Lindskog, S., Serlachius, E., Hedman‐Lagerlöf, E., Ljótsson, B., et al. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.1937695 · Cited by 11
“The PHQ-2 possesses high levels of internal reliability and is highly sensitive/specific to the presence of a diagnosis of Major Depression as assessed by clinical interview (Arroll et al., 2010).”
Pain and Opioid Consumption Following Endoscopic Sinus Surgery: A Prospective Cohort Study
Pandrangi, V. C., Scott, B. L., Pailet, J., Mace, J. C., Farrell, N. F., Geltzeiler, M. N., Smith, T. L., & Detwiller, K. Y. (2021) · The Laryngoscope · doi:10.1002/lary.29967 · Cited by 8
“Preoperative Anxiety, Depression, and Pain The Generalized Anxiety Disorder 2-item test (GAD-2) and the Patient Health Questionnaire-2 (PHQ-2) were administered at the preoperative visit to quantify the severity of preoperative anxiety and depression.(9,10) Anxiety was defined as either a selfreported medical history…”
Method
The Relationship Between eHealth Literacy and Mental Health of Adult Workers: A Cross-Sectional Study
Zhao, Y., Zhao, Y., Xie, Z., Ziyadan, P., Xiu, Z., & Qi, M. (2023) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20230322-01 · Cited by 9
The Impact of a Healthy Lifestyle on Psychological Well-Being Among Saudi Adolescent Girls Attending Secondary Schools in Taif City, Saudi Arabia
Baz, S. S. B., Malibarey, W. M., Alsalmi, H. A., Alzaydi, M. D., Alqahtani, A. M., & Alghamdi, R. (2023) · Cureus · doi:10.7759/cureus.50189 · Cited by 8
“The level of depression in students was categorized as follows as per the total scores: minimal depression (1-4), mild depression (5-9), moderate depression (10-14), moderately severe (15-19), and severe (20-27) [13].”
Background
Frailty and decisional regret after elective noncardiac surgery: a multicentre prospective cohort study
Agung, Y., Hladkowicz, E., Boland, L., Moloo, H., Lavallée, L. T., Lalu, M. M., & McIsaac, D. I. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.08.001 · Cited by 8
“…included in the Elixhauser set, 26 cognitive status (AD8 score 27 ), baseline disability score, 28 and risk of depression or anxiety (PHQ-2 29 ), along with the surgical specialty (ortho-paedics [primarily total joint arthroplasty], abdominal [primarily general surgery, urology, and…”
Background
Impairment reduction in older dizzy people in primary care: study protocol for a cluster randomised controlled trial
Stam, H., van der Wouden, J. C., van der Horst, H. E., & Maarsingh, O. R. (2015) · Trials · doi:10.1186/s13063-015-0848-1 · Cited by 8
“Patients who still have elevated anxiety or depression symptom scores (a GAD-7 score ≥10, a PHQ-9 score ≥10, or a positive PHQ-PD score) after concluding a step will be invited to participate in the next step.”
Influential
A prospective study assessing agreement and reliability of a geriatric evaluation
Locatelli, I., Monod, S., Cornuz, J., Büla, C., & Senn, N. (2017) · BMC Geriatrics · doi:10.1186/s12877-017-0546-9 · Cited by 8
“Referring to the reliability classification introduced by Altman [21], reliability was poor for visual impairment and malnutrition (3w-ICC < 0.2); moderate for Dependent 6[30] aKatz’s basic activities of daily living (ADL) [13]: score from 0 to 6, higher score indicating greater independence. bLawton’s instrumental AD…”
BackgroundMethodInfluential
Attention-Deficit/Hyperactivity Disorder Symptoms, Depression Risk, and Quality of Life in Black Pregnant Women
Jones, H. A., Eddy, L. D., Bourchtein, E., Parks, A. M., Green, T., Karjane, N. W., & Svikis, D. S. (2018) · Journal of Women s Health · doi:10.1089/jwh.2017.6547 · Cited by 8
“35,36 Its brief nature makes it an appropriate screen for depression in a medical setting, 37 as it measures for the presence of two symptoms of depression.”
Association between Physical Activity and Depressive Mood among Korean Adults with Chronic Diseases
Park, S.-Y., Lee, K., Um, Y. J., Paek, S., & Ryou, I. S. (2018) · Korean Journal of Family Medicine · doi:10.4082/kjfm.2018.39.3.185 · Cited by 8
Help-seeking behavior among community-dwelling adults with chronic pain
Mann, E. G., VanDenKerkhof, E. G., Johnson, A. P., & Gilron, I. (2019) · Canadian Journal of Pain · doi:10.1080/24740527.2019.1570095 · Cited by 8
“yields a specificity and sensitivity of 88% for major depression compared with diagnoses made via interviews by mental health professionals.(35,36) This tool is widely available and is considered appropriate for use in ethnically diverse groups.”
Impact of Affect on Lung Transplant Candidate Outcomes
Pennington, K. M., Benzo, R. P., Schneekloth, T. D., Budev, M. M., Chandrashekaran, S., Erasmus, D. B., Lease, E. D., Levine, D. J., Thompson, K. L., Stevens, E., et al. (2019) · Progress in Transplantation · doi:10.1177/1526924819892921 · Cited by 9
The effect of psychological resilience on functional outcomes in post-operative hip fracture patients in a Singapore community hospital
Tan, C. Y. F., Fang, H. S. A., Koh, Y. L. E., & Low, L. L. (2020) · Proceedings of Singapore Healthcare · doi:10.1177/2010105820948531 · Cited by 8
Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative
Park, P., Chang, V. W., Yeh, H.-H. H., Schwalb, J. M., Nerenz, D. R., Schultz, L. R., Abdulhak, M. M., Easton, R. W., Perez-Cruet, M., Kashlan, O. N., et al. (2020) · Journal of Neurosurgery Spine · doi:10.3171/2020.7.spine20729 · Cited by 8
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Jacobs, C. A., Conley, C., Kraus, V. B., Lansdown, D. A., Lau, B. C., Li, X., Majumdar, S., Spindler, K. P., Lemaster, N. G., & Stone, A. V. (2022) · Trials · doi:10.1186/s13063-021-05982-3 · Cited by 8
“been bothered by specific symptoms in the last 2 weeks [46, 47].”
Background
Sleep pattern and predictors of daily versus as-needed hypnotics use in middle-aged and older adults with insomnia
Tanielian, M., Antoun, J., Sidani, M., Halabi, A., Hoballah, M. M., Hawatian, K., & Assaf, G. (2022) · BMC Family Practice · doi:10.1186/s12875-022-01707-w · Cited by 8
“The more words patients were able to recall, the better their episodic memory was considered [35].”
Background
Dynamics of sadness by race, ethnicity, and income following George Floyd's death
Lin, J., Shaw, P., Curtis, B. L., Ungar, L., & Koehly, L. M. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100134 · Cited by 8
Burnout, Surface Acting, and Suicidal Ideation Among Military Personnel: Results of a Longitudinal Cohort Study
Bryan, C. J., Bryan, A. O., Baker, J. C., Ammendola, E., & Szeto, E. (2022) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2022.41.6.593 · Cited by 8
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“In that sense, the PHQ-2 and GAD-2, which have already been validated as having high sensitivity and specificity as the PHQ-9 and GAD-7, may be regarded as useful screeners and efficient tools for monitoring treatment progress and outcomes in primary medical settings [21,39-43].”
Determinants of depression and anxiety in homeless people: A population survey of homeless people in Hong Kong
Chan, S., Wong, H., Chen, Y., & Tang, M.-Y. V. (2023) · International Journal of Social Psychiatry · doi:10.1177/00207640231152208 · Cited by 8
“The PHQ measurement was validated as having high sensitivity in detecting major depression (Arroll et al., 2010; Löwe et al., 2005).”
Method
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Characteristics of Mothers with Depressive Symptoms Outside the Postpartum Period
Rosenthal, D. G., Learned, N., Liu, Y., & Weitzman, M. L. (2012) · Maternal and Child Health Journal · doi:10.1007/s10995-012-1084-x · Cited by 8
A Retrospective, Pilot Study of De Novo Antidepressant Medication Initiation in Intensive Care Unit Patients and Post-ICU Depression
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Apesoa‐Varano, E. C. (2018) · Sociological Perspectives · doi:10.1177/0731121417753372 · Cited by 8
Response to Tomalski et al. (2019): Recommendations for Adapting a Comprehensive Athlete Mental Health Screening Program for Broad Dissemination
Rancourt, D., Brauer, A. A., Palermo, M., Choquette, E. M., & Stanley, C. T. (2020) · Journal of Sport Psychology in Action · doi:10.1080/21520704.2020.1722770 · Cited by 9
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Acute Vestibular Syndrome and ER Presentations of Dizziness
Baron, R., Steenerson, K. K., & Alyono, J. C. (2021) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2021.05.013 · Cited by 9
The importance of employment to workers with preexisting behavioral health disorders during the COVID-19 pandemic.
Cook, J. Α., Swarbrick, M. A., Boss, K. A., Steigman, P. J., Nemec, P. B., Jonikas, J. A., Brice, G. H., & Aranda, F. (2021) · Psychiatric Rehabilitation Journal · doi:10.1037/prj0000499 · Cited by 8
Unmet need for treatment of depression among immigrants from the former USSR in the US: A primary care study
Landa, A., Skritskaya, N. A., Nicasio, A., Humensky, J. L., & Lewis‐Fernández, R. (2015) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217415610320 · Cited by 8
“’’(22) This method has good validity in identifying cases of MDD in primary care settings.(23,24) In our sample, the internal consistency of the scale was good (a1⁄4 .”
Method
Audio-Based Detection of Anxiety and Depression via Vocal Biomarkers
Brueckner, R., Kwon, N., Subramanian, V., Blaylock, N., & O’Connell, H. (2024) · Lecture notes in networks and systems · doi:10.1007/978-3-031-53960-2_9 · Cited by 7
Development and psychometric evaluation of a questionnaire for the assessment of depression in primary care: a cross-sectional study
Teusen, C., Bühner, M., Hapfelmeier, A., von Schrottenberg, V., Linde, K., Gensichen, J. S., & Schneider, A. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-084102 · Cited by 7
Validation of the patient health questionnaire (PHQ)-9 and PHQ-2 in patients with COPD in China
Liu, M., Chang, Y., Wang, D., Fang, J., Carson, S. S., Li, B., Hu, Y., & Huang, K. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07052-3 · Cited by 7
“Another study reported that a PHQ-2 score of ≥ 2 had a sensitivity of 86% and specificity of 78% for MDD in a primary care population in New Zealand [26].”
The emotional-behavioral state of Israeli adolescent and young adult females with anorexia nervosa during the COVID19 pandemic
Serur, Y., Dikstein, H., Shilton, T., Gothelf, D., Latzer, Y., Lewis, Y. D., Enoch‐Levy, A., Pessach, I. M., Gur, E., & Stein, D. J. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00668-w · Cited by 8
“[38, 39] This 9-item depression module from the PHQ is rated on a 3-point Likert scale, with higher scores indicating greater depression.”
Method

Authors: Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., Falloon, K., & Hatcher, S.
Affiliations: University of Auckland (NZ)
ORCID: Arroll, B.
Crengle, S.
Gunn, J.
Kerse, N.
Falloon, K.
Hatcher, S.
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: 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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Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population

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