Depression & Anxiety Screener (PHQ-4)

30 seconds to know where you stand

If you have been feeling off lately — poor sleep, low energy, restlessness, overthinking — but cannot quite say what is wrong, the PHQ-4 is for you.

The PHQ-4 is the shortest validated screening tool, developed by Kroenke, Spitzer, Williams, and Löwe in 2009. Just 4 items, yet it covers the two core symptom clusters of both anxiety and depression:

• First 2 items (GAD-2): core anxiety symptoms — feeling nervous, uncontrollable worry
• Last 2 items (PHQ-2): core depressive symptoms — low mood, loss of interest

In a validation study of 2,149 primary-care patients, the PHQ-4 separated anxiety and depression into two distinct factors (explaining 84% of the variance), and higher scores were strongly associated with functional impairment and healthcare use.

What the scores mean

• 0-2: Normal — little to no distress
• 3-5: Mild distress
• 6-8: Moderate distress — a full assessment is recommended
• 9-12: Severe distress — professional help is recommended as soon as possible

After screening: your next step

The PHQ-4's job is triage, not a final answer. It captures only the core signals; the full screeners provide severity grading:

• Anxiety subscale (first 2 items) of 3 or more → take the GAD-7 (7 items, about 3 minutes)
• Depression subscale (last 2 items) of 3 or more → take the PHQ-9 (9 items, about 3 minutes)

This follows a validated clinical workflow: 30 seconds to find the direction, then a full screener to confirm the degree. After the GAD-7 or PHQ-9 you will get a precise severity rating and tailored advice.

Psychometric notes

• Construct validity: two-factor model fit well (RMSEA 0.027, Löwe 2010)
• Completion time: about 30 seconds

This is a screening tool, not a diagnosis. If your score worries you, complete the corresponding full screener and, if needed, consult a healthcare professional.