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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Method
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Ho, E. Y., Karliner, L., Leung, G. Y., Harb, R., Ramirez, G. A., & Garcia, M. E. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.107850 · Cited by 3
Current Insights into the Use of Probiotics and Fatty Acids in Alleviating Depression
Gao, H., He, C., Xin, S., Hua, R., Du, Y., Wang, B., Gong, F., Yu, X., Pan, L., Gao, L., et al. (2023) · Microorganisms · doi:10.3390/microorganisms11082018 · Cited by 3
“In primary care settings, a score of 2 or higher on the Patient Health Questionnaire 2 (PHQ-2) survey, which is widely utilized for diagnosis, has a sensitivity of 86% and a specificity of 78% [6].”
Background
The DrinksRation Smartphone App for Modifying Alcohol Use Behaviors in UK Military Service Personnel at Risk of Alcohol-Related Harm: Protocol for a Randomized Controlled Trial
King, K., Leightley, D., Greenberg, N. L., & Fear, N. T. (2023) · JMIR Research Protocols · doi:10.2196/49918 · Cited by 4
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Mirsky, J. B., Brodney, S., Boratyn, V., & Thorndike, A. N. (2023) · American Journal of Lifestyle Medicine · doi:10.1177/15598276231208164 · Cited by 3
Impact of the COVID-19 Pandemic on Indicators of Psychological Health and Suicidal Ideation Within an Active Duty U.S. Military Population
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Chatrath, S., Loiselle, A. R., Johnson, J. K., & Begolka, W. S. (2024) · Skin Health and Disease · doi:10.1002/ski2.408 · Cited by 5
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Cao, T., Tian, M., Hu, H. H., Wu, H., Yu, Q., Su, X., Wang, R., Zhang, Q., An, Z., Song, J., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.07.063 · Cited by 3
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Caregiver Depressive Symptoms Associated with Behavioral and Emotional Problems in Preschoolers
Fallucco, E. M., Greco, P., Aldridge, P. J., & Blackmore, E. R. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01573-8 · Cited by 3
Development and validation of the hypersomnia-specific beliefs scale
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“Scores of 20 or greater are usually indicative of severe depression (Arroll et al., 2010).”
BackgroundInfluential
Addressing depression and behavioral health needs through a digital program at scale
Sharif-Sidi, Z., Shen, C. P., Wong, W., Hanson, R., Miller, L. A., Fickel, K., Green, E., Burns, J., Dunn, C., Somai, M. M., et al. (2021) · Healthcare · doi:10.1016/j.hjdsi.2021.100521 · Cited by 3
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“…acceptable psychometric support for routine use in various noninstitutional community mental health and medical settings (e.g., Aben et al ., 2002; Arroll et al ., 2010; Beard et al ., 2016; Karim et al ., 2015; Watnick et al ., 2005), few have been developed and validated on correctional…”
Vaping, lung injury, and mental health Minnesota 2018-2019.
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Diagnosis and Management of Perinatal Depression
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Depressive Symptoms Are Associated with Self-Reported Physical Limitations That Are Activity Dependent in a Cross-Sectional Analysis of Subjects with Chronic Obstructive Pulmonary Disease
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“Prior studies demonstrate that a PHQ-9 score 10 has a sensitivity of 70–90% and specificity of 90% for the diagnosis of major depression (13,14).”
Background
Lack of impact of radiologic septal measurements upon patient symptoms and performance of septoplasty during endoscopic sinus surgery
Rowan, N. R., Soler, Z. M., Mace, J. C., Camilon, M. P., Palmer, C., Jones, R. H., Smith, T. L., & Schlosser, R. J. (2020) · Rhinology Journal · doi:10.4193/rhin19.412 · Cited by 3
“(16–18) Meanwhile, the SF-6D instrument was used to detail current health states using a normalized health utility value,(19) the Patient Health Questionnaire-2 (PHQ-2) was used as a measure of depressive symptoms,(20) and the Pittsburgh Sleep Quality Index (PSQI) assessed participant sleep quality.”
Method
Testing the Synergistic Effects of Depression, Anxiety, and Substance Use in Unsafe Sex: a Cross-sectional Study
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“In our empirical investigations we primarily focus on the effects of severe depression (PHQ-9 ≥ 15), which is sometimes used as a threshold for referral to psychiatric treatment (Arroll et al. 2010).”
Background
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Method
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Background
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“The PHQ-A is an expanded version of the PHQ-9 developed specifically for adolescents and includes addi - tional questions assessing persistent depressive disorder and suicide risk; it has demonstrated appropriate validity and reliability in assessing depressive symptoms among adolescents in the primary care setting, w…”
Influential
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“Collection 1 Train IDs: [ROSJJNIB3, CVCXR3FZV, 4IGU5ZQWZ, SGVN7E3SM, C4NCER7RE, G507LQZ5X, 18SVPE1ZJ, GZU3KNP1E,4IGB4DKMP,EE1MNQTUT,XRN7RMADR,ZNQ5Z1Q9I,QBEZBGLGH,U164N2SEN,HU0TL00AD,BS6OWRWT3, H8IBT4OV0,2W1EYGWM0,846CD4CAG,V8BP0D8P3,9RFJU57JW,YDYRIKI3H,8CLVULOIO,0FX9FNBH3,ZE5QAUQQL, ALJ5BW5DT,0NZH3ULXB,C06F1T857,9IS90…”
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“Depressive symptoms are measured using the 9-item PHQ-9 [40].”
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Endogenous analgesia, assessed via conditioned pain modulation, is not different in people with hip osteoarthritis compared to controls: a cross-sectional study
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Night Eating Syndrome and Associated Psychosocial Health Profile among Medical Students: A Cross-Sectional Study in Central India
Singh, H., Khan, M. F., Selvaraj, K., Dani, A., & Akkilagunta, S. (2025) · International Journal of Social Psychiatry · doi:10.1177/00207640251369135 · Cited by 2
“This tool has been effective with reasonably good sensitivity and specificity of 61% and 92% respectively for detecting major depression based on the cutoff score of 3 or greater in primary care patients (Arroll et al., 2010).”
Intersections of sexual orientation, gender identity, and race/ethnicity and odds of reporting depression and anxiety symptomology in the Household Pulse Survey
Ingle, C., Anderson, R. E., & Williams, A. (2025) · Journal of Mental Health · doi:10.1080/09638237.2025.2558508 · Cited by 2
“The PHQ-2 is a validated measure that screens for Major Depressive Disorder and has been validated across the general population (Arrieta et al., 2017; Arroll et al., 2010).”
Comparison of Adolescent Depression Screening Using Orally Administered Versus Written Self-Report Scores
Batra, E. K., Tuan, W., Sekhar, D. L., Merai, R., Shi, T., & Fogel, B. N. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251374583 · Cited by 2
“Patient Health Questionnaire-2 (PHQ-2) The PHQ-2 is a brief, 2 question, validated depression screener 18,19 that inquires about symptoms in the last 2 weeks.”

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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