PHQ-4 scoring: what your score means
CareOps editorial team · · 5 min read
Mental wellness information and service guidance published by CareOps.
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The CareOps editorial team publishes these guides. Sources are linked at the end of each article; examples are illustrative, not customer stories. Product descriptions refer to CareOps Maeumi. Publication and revision dates appear above.
Read our full editorial standards →The PHQ-4 is the shortest widely used check for anxiety and depression: four questions, about a minute. That makes it easy to take and easy to misread. A single total hides two separate scores inside it, and those two scores are what tell you which way to look next. Here is how it is scored and how to read your result.
At a glance
- The PHQ-4 has four items scored 0–3: two from the GAD-2 (anxiety) and two from the PHQ-2 (depression). The total runs from 0 to 12.
- Published bands: 0–2 normal, 3–5 mild, 6–8 moderate, 9–12 severe psychological distress.
- Look at the two pairs separately: 3 or more on either pair is a positive screen for that side and a reason for a fuller check.
What the PHQ-4 is
The PHQ-4 was published in 2009 by Kurt Kroenke and colleagues. It joins two ultra-brief screeners that were already validated on their own: the GAD-2 for anxiety and the PHQ-2 for depression. In data from 2,149 patients at 15 primary-care clinics in the United States, the four items split cleanly into two factors, anxiety and depression, and higher scores were strongly linked with difficulty in daily functioning, days lost to disability and healthcare use.
Its job is screening: a quick first look at whether anxiety or low mood has been a problem over the past two weeks. It is a screening tool, not a diagnosis.
What the four questions ask about
All four ask how often something has bothered you over the past two weeks. The first two are the anxiety pair: feeling nervous, anxious or on edge, and not being able to stop or control worrying. The last two are the depression pair: having little interest or pleasure in doing things, and feeling down, depressed or hopeless.
How is the PHQ-4 scored?
- Score each answer 0–3: not at all (0), several days (1), more than half the days (2), nearly every day (3). No items are reverse-scored.
- Add the two anxiety items. This is your GAD-2 score, 0–6.
- Add the two depression items. This is your PHQ-2 score, 0–6.
- Add both pairs together for the PHQ-4 total, 0–12.
What does my PHQ-4 score mean?
The total gives an overall sense of psychological distress. These are the bands published with the scale:
| Total score | Band | How to read it |
|---|---|---|
| 0–2 | Normal | Few symptoms over the past two weeks |
| 3–5 | Mild | Some symptoms; worth keeping an eye on |
| 6–8 | Moderate | A fuller check is a good next step |
| 9–12 | Severe | Worth talking with a professional soon |
The two pairs matter as much as the total. A score of 3 or more on the anxiety pair is a positive screen for anxiety; 3 or more on the depression pair is a positive screen for depression. Someone with a total of 4 could have 4 on anxiety and 0 on depression, or 2 on each, and those point in different directions.
A positive screen does not mean you have a disorder. It means a longer questionnaire is the next step: the GAD-7 for the anxiety side and the PHQ-9 for the depression side. See anxiety tests compared and depression tests compared for what each one covers.
Three examples
- Total 2 (anxiety 1, depression 1): normal range, neither pair at 3. Nothing to follow up beyond noticing how you feel.
- Total 5 (anxiety 4, depression 1): mild overall, but the anxiety pair screens positive. A GAD-7 would show more.
- Total 9 (anxiety 4, depression 5): severe range with both pairs positive. Take the fuller checks and consider talking with a licensed professional.
Because the PHQ-4 asks about the past two weeks, retaking it every two weeks or so shows whether things are moving. Stress can push scores up for a while; for the difference, see anxiety vs. stress.
Take the free PHQ-4 check
Our check scores the total and both pairs for you and shows which band you fall in. It takes about a minute.
Try a self-assessment without signing inBrief mood and anxiety screen (PHQ-4)Mood and anxiety in four questions. Answer the app’s questionnaire and see your result right away.Start the check →After the score
CareOps Maeumi is an AI counseling app that starts with short self-checks like the PHQ-4, then helps you understand what is behind the numbers and practice small steps. It remembers earlier sessions, so each conversation builds on the last, by voice or text. The first session is free, and you can use it alongside care from a licensed professional.
Frequently asked questions
- How is the PHQ-4 scored?
- Each of the four items is scored 0–3, from not at all to nearly every day. The two anxiety items make the GAD-2 score (0–6), the two depression items make the PHQ-2 score (0–6), and together they give the PHQ-4 total of 0–12. No items are reverse-scored.
- What does a PHQ-4 score of 6 mean?
- A total of 6 falls in the moderate band (6–8). Check the two pairs too: if either the anxiety or the depression pair is 3 or more, that side screens positive, and a fuller check such as the GAD-7 or PHQ-9 is a good next step.
- What is a positive PHQ-4 screen?
- A score of 3 or more on the anxiety pair (GAD-2) or on the depression pair (PHQ-2). It suggests a longer questionnaire is worth taking; it is not a diagnosis.
- How is the PHQ-4 different from the PHQ-9 and GAD-7?
- The PHQ-4 is a four-item first look at both anxiety and depression. The PHQ-9 and GAD-7 are longer checks that each focus on one of them and give a more detailed picture.
Sources
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