The DOI matches its Crossref record; 19 of the 19 references it cites were found in a registry or an index.
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]
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=.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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Citations
Cites
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The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003) · Medical Care · doi:10.1097/01.mlr.0000093487.78664.3c · Cited by 6,359
Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD Initiative.
Bossuyt, P. M., Reitsma, J. B., Bruns, D. E., Gatsonis, C. A., Glasziou, P. P., Irwig, L. M., Lijmer, J. G., Moher, D., Rennie, D., de Vet, H. C. W., et al. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-1-200301070-00010 · Cited by 3,219
Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative
Bossuyt, P. M., Reitsma, J. B., Bruns, D. E., Gatsonis, C. A., Glasziou, P. P., Irwig, L. M., Lijmer, J. G., Moher, D., Rennie, D., & de Vet, H. C. W. (2003) · BMJ · doi:10.1136/bmj.326.7379.41 · Cited by 3,215
Users' Guides to the Medical Literature
Guyatt, G. H. (1993) · JAMA · doi:10.1001/jama.270.17.2096 · Cited by 3,083
Detecting and monitoring depression with a two-item questionnaire (PHQ-2)
Löwe, B., Kroenke, K., & Gräfe, K. (2005) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2004.09.006 · Cited by 1,473
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Flagged first, then by citations
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- Ministry of Health. Taking the Pulse. The 1996/97 New Zealand Health Survey. Wellington: Ministry of Health; 1999:197-202.
- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.
Cited by
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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
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“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
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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