Patient Health Questionnaire-4 (PHQ-4)
The PHQ-4 uses four questions from the GAD-7 and PHQ-9 to reflect anxiety and depressive symptoms over the past two weeks. It gives one total and two subscores, not a diagnosis.
Evidence passport
Instrument and scoring
- Scientific name
- Patient Health Questionnaire-4 (PHQ-4)
- NuraCheck implementation version
- 1.0.0
- Scoring method
- Published sum score
- Score shown
- Overall score and dimensions
- Primary reference
- Kroenke K, Spitzer RL, Williams JBW, Löwe B. An Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ-4. Psychosomatics. 2009;50(6):613–621. Open publication
- Published scoring source
- No separate source is recorded for this field.
- Exact form or administration source
- No separate source is recorded for this field.
Who and where the evidence may apply
Evidence comes from particular studies and language versions, so its relevance can vary.
- Intended audience
- Adults seeking a very brief starting point for anxiety and depressive symptoms.
- Language version shown
- English (en) · Base wording used by this NuraCheck implementation
- Study participants and settings
- The cited study included 2,149 patients from 15 US primary-care clinics. It supports an ultra-brief combined mood-and-anxiety measure in that setting, not a diagnosis or equal performance across every population.
Review the study used for these details
Scores do not capture culture, minority stress, disability or barriers to support. These factors can shape responses.
The evidence cannot determine whether a questionnaire fits you personally. NuraCheck does not ask for or infer identity to decide this.
Language provenance
- Language version shown
- English (en) · Base wording used by this NuraCheck implementation
- Wording scope
- Full instrument
- Independent language review
- Not recorded separately for the base wording
Base-wording source recorded by NuraCheck
Language provenance and independent validation are different. NuraCheck does not infer a reviewer or review date when the evidence record does not name one.
Licence and permitted use
- Licence status
- Permission granted
- Rights holder or steward
- Pfizer Inc.; Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues
- Permission record checked
- Jul 14, 2026
- Electronic use
- Allowed by the reviewed permission record
- Translation
- Allowed by the reviewed permission record
PHQ-4 © Pfizer Inc.; developed by Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues.
What this questionnaire cannot answer
With four questions, the PHQ-4 offers less detail than the PHQ-9 or GAD-7. Similar symptoms can have many causes.
Compare nearby questionnaire options
These questionnaires overlap, but they answer different reflection questions. Choose one based on scope and time; you do not need to complete all of them.
PHQ-4 is the shortest option and combines two mood and two anxiety questions. PHQ-9 is mood-focused; GAD-7 is anxiety-focused.
Patient Health Questionnaire-9 (PHQ-9)
- What it covers
- Reflect on low mood, loss of interest, sleep, energy and related experiences over the past two weeks.
- Time
- 3 min · 9 questions
- What this cannot tell you
- The score does not capture context, duration, daily impact, physical health or other explanations. Any response above zero to item 9 deserves prompt attention.
Generalized Anxiety Disorder-7 (GAD-7)
- What it covers
- Reflect on worry, tension, restlessness and related anxiety experiences over the past two weeks.
- Time
- 2 min · 7 questions
- What this cannot tell you
- The score does not explain the cause of these experiences. Other conditions, circumstances and physical health factors can produce similar symptoms.
What this covers
- Anxiety symptoms
- Frequency of the two GAD-2 anxiety symptoms during the past two weeks.
- Depressive symptoms
- Frequency of the two PHQ-2 depressive symptoms during the past two weeks.
What your result can show
Anxiety and depressive symptom pairs are also shown from 0–6; these ranges describe reported symptom frequency only.
Important limitations
With four questions, the PHQ-4 offers less detail than the PHQ-9 or GAD-7. Similar symptoms can have many causes.