The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener

Background. A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2. Methods. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 (“not at all”) to 3 (“nearly every day”). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics–gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results. As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score ≥3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics–gynecology samples. Conclusion. The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.

[1]  A. Dietrich,et al.  A three-component model for reengineering systems for the treatment of depression in primary care. , 2002, Psychosomatics.

[2]  Alfred O. Berg,et al.  Screening for Depression: Recommendations and Rationale , 2002, Annals of Internal Medicine.

[3]  G. Ramirez,et al.  Identifying depression in primary care: a literature synthesis of case-finding instruments. , 2002, General hospital psychiatry.

[4]  U. P. S. T. Force.  Screening for depression: recommendations and rationale. , 2002, American family physician.

[5]  P. Noël,et al.  Is this patient clinically depressed? , 2002, JAMA.

[6]  K. Kroenke.  Depression Screening Is Not Enough , 2001, Annals of Internal Medicine.

[7]  J. Zeber,et al.  The cost-utility of screening for depression in primary care. , 2001, Annals of internal medicine.

[8]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[9]  R. Spitzer,et al.  Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. , 2000, American journal of obstetrics and gynecology.

[10]  A. Dietrich,et al.  Interventions to improve provider diagnosis and treatment of mental disorders in primary care. A critical review of the literature. , 2000, Psychosomatics.

[11]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[12]  C. Mulrow,et al.  Case-finding for depression in primary care: a randomized trial. , 1999, The American journal of medicine.

[13]  W. Katon,et al.  Should anxiety and insomnia influence antidepressant selection: a randomized comparison of fluoxetine and imipramine. , 1998, The Journal of clinical psychiatry.

[14]  J. Williams.  Competing demands , 1998 .

[15]  J. Williams,et al.  Competing demands: Does care for depression fit in primary care? , 1998, Journal of general internal medicine.

[16]  G. Simon.  Can depression be managed appropriately in primary care? , 1998, The Journal of clinical psychiatry.

[17]  K. Kroenke.  Discovering Depression in Medical Patients: Reasonable Expectations , 1997, Annals of Internal Medicine.

[18]  M. Klinkman,et al.  Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. , 1997, General hospital psychiatry.

[19]  W. Browner,et al.  Case-finding instruments for depression. Two questions are as good as many. , 1997, Journal of general internal medicine.

[20]  C. Mulrow,et al.  Case-Finding Instruments for Depression in Primary Care Settings , 1995, Annals of Internal Medicine.

[21]  K Kroenke,et al.  Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. , 1994, JAMA.

[22]  R. Spitzer.  Utility of new procedure for diagnosing mental disorders in primary care , 1994 .

[23]  A. O. Hughes,et al.  Clinical epidemiology a basic science for clinical medicine (2nd edition). David L. Sackett, R. Brian Haynes, Gordon H. Guyatt, Peter Tugwell, Little Brown and company, Bosten, 1991. no. of pages: xvii+441. price: £23.95, $32.50. ISBn: 0316‐76599‐6 , 1993 .

[24]  M. First,et al.  The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. , 1992, Archives of general psychiatry.

[25]  M Davies,et al.  The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. , 1992 .

[26]  M. Weinstein,et al.  Performance of a Five-Item Mental Health Screening Test , 1991, Medical care.

[27]  Lewis E. Kazis,et al.  Effect Sizes for Interpreting Changes in Health Status , 1989, Medical care.

[28]  A. Stewart,et al.  The MOS short-form general health survey. Reliability and validity in a patient population. , 1988, Medical care.

[29]  J. Freiman.  Screening for alcohol abuse using the CAGE questionnaire. , 1987, The American journal of medicine.

[30]  M C Weinstein,et al.  Performance of screening and diagnostic tests. Application of receiver operating characteristic analysis. , 1987, Archives of general psychiatry.

[31]  D. Sackett,et al.  The Ends of Human Life: Medical Ethics in a Liberal Polity , 1992, Annals of Internal Medicine.