Patient Health Questionnaire

The Patient Health Questionnaire (PHQ) is a widely used, evidence-based tool designed to help identify and assess common mental health concerns. Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and their colleagues, with an educational grant from Pfizer Inc., the PHQ provides a structured set of questions that can guide individuals and healthcare professionals in evaluating symptoms related to depression, anxiety, and several other emotional or behavioral issues. By offering a clear, concise snapshot of a person’s current mental state, the PHQ can facilitate early detection of potential challenges and encourage timely intervention. This resource is often embraced by therapists, primary care providers, and other healthcare professionals to supplement clinical interviews, gauge treatment progress, and start important conversations about emotional well-being.

As a screening instrument, the PHQ is unique in its adaptability and user-friendly design. It is separated into different sections that each focus on specific conditions, such as the PHQ-9 for depression and the GAD-7 (Generalized Anxiety Disorder-7) when anxiety is a concern. These sections guide individuals through questions regarding their feelings, thoughts, and behaviors, requiring them to rate the frequency or intensity of certain experiences—for instance, how often they have felt sad or hopeless over the past two weeks. The PHQ’s straightforward wording makes it accessible to people with varying backgrounds and education levels. Most sections can be completed in just a few minutes, ensuring that it minimally disrupts a therapy session or doctor’s visit, while still providing valuable insights.

Because the PHQ is a self-report measure, it empowers individuals to participate actively in their own care. For some clients, answering these questions can be an important step in acknowledging how they have been feeling and recognizing that it may be time to seek professional help. At the same time, the PHQ provides therapists with a consistent way to detect changes in a client’s mood and overall well-being. This dual function makes the PHQ an important collaboration tool, fostering open dialogue between the therapist and client about next steps in care, whether that involves continued assessment, therapeutic interventions, lifestyle changes, medication consultation, or other approaches.

The PHQ is considered both reliable and valid for many clinical populations, having been subjected to extensive research and peer review. Several studies have affirmed its accuracy in identifying conditions like major depressive disorder and generalized anxiety disorder, thereby making it a trusted aid for healthcare practitioners. However, it is important to stress that the PHQ does not replace a formal, comprehensive evaluation by a mental health professional. Instead, it serves as an efficient way to recognize concerns and encourage further discussion, enabling a more holistic diagnosis and treatment plan.

Clinicians often use PHQ results to guide therapeutic strategies and to measure how well a treatment approach is working over time. For instance, if someone’s PHQ-9 score for depressive symptoms decreases between sessions, it can indicate that a particular intervention—such as cognitive behavioral therapy, medication, or mindfulness-based strategies—may be effective. On the other hand, if symptoms worsen, the therapist can adjust and refine the treatment plan accordingly. This flexibility and responsiveness are key benefits of incorporating the PHQ into regular clinical practice.

For individuals who feel uncertain or anxious about their emotional health, the PHQ can serve as a gentle first step. It helps crystallize one’s experiences into a format that can be shared with a therapist or physician, making it easier to communicate the nature and severity of concerns. The questionnaire’s brevity and familiar style of questions offer a sense of reassurance and confidentiality. Moreover, because the tool has been studied across diverse populations, there is considerable confidence that it can capture a wide range of emotional challenges in an accurate way.

In summary, the Patient Health Questionnaire is a practical and widely recognized self-assessment instrument that helps shine a light on an individual’s emotional and behavioral health. Its streamlined design and proven reliability make it a useful starting point in detecting or monitoring conditions such as depression, anxiety, and other mental health concerns. By facilitating open, informed conversations between clients and healthcare providers, the PHQ promotes a comprehensive understanding of a person’s well-being, paving the way for supportive and effective therapeutic interventions.

The questions from the assessment are listed below.

During the last 4 weeks, how much have you been bothered by any of the following problems?

Stomach pain
Back pain
Pain in your arms, legs, or joints (knees, hips, etc.)
Menstrual cramps or other problems with your periods
Pain or problems during sexual intercourse
Headaches
Chest pain
Dizziness
Fainting
Heart racing or pounding
Shortness of breath
Constipation, loose bowels, or diarrhea
Nausea, gas, or indigestion

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead or of hurting yourself in some way

Questions about anxiety.

In the last 4 weeks, have you had an anxiety attack — suddenly feeling fear or panic?
Has this ever happened before?
Do some of these attacks come suddenly out of the blue — that is, in situations where you don’t expect to be nervous or uncomfortable?
Do these attacks bother you a lot or are you worried about having another attack?

Think about your last bad anxiety attack.

Were you short of breath?
Did your heart race, pound, or skip?
Did you have chest pain or pressure?
Did you sweat?
Did you feel as if you were choking?
Did you have hot flashes or chills?
Did you have nausea or an upset stomach, or the feeling that you were going to have diarrhea?
Did you feel dizzy, unsteady, or faint?
Did you have tingling or numbness in parts of your body?
Did you tremble or shake?
Were you afraid you were dying?

Over the last 4 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious, on edge, or worrying a lot about different things.
Feeling restless so that it is hard to sit still.
Getting tired very easily.
Muscle tension, aches, or soreness.
Trouble falling asleep or staying asleep.
Trouble concentrating on things, such as reading a book or watching TV.
Becoming easily annoyed or irritable.

Questions about eating.

Do you often feel that you can’t control WHAT or HOW MUCH you eat?
Do you often eat, WITHIN ANY 2-HOUR PERIOD, what most people would regard as an unusually LARGE amount of food?
Has this been as often, on average, as twice a week for the last 3 months?

In the last 3 months have you OFTEN done any of the following in order to avoid gaining weight?

Made yourself vomit?
Took more than twice the recommended dose of laxatives?
Fasted — not eaten anything at all for at least 24 hours?
Exercised for more than an hour specifically to avoid gaining weight after binge eating?

If you checked “YES” to any of the ways of avoiding gaining weight, were any as often, on average, as twice a week?

Do you ever drink alcohol (including beer or wine)?

Have any of the following happened to you MORE THAN ONCE IN THE LAST 6 MONTHS?

You drank alcohol even though a doctor suggested that you stop drinking because of a problem with your health.
You drank alcohol, were high from alcohol, or hung over while you were working, going to school, or taking care of children or other responsibilities.
You missed or were late for work, school, or other activities because you were drinking or hung over.
You had a problem getting along with other people while you were drinking.
You drove a car after having several drinks or after drinking too much.

If you checked off ANY problems, how DIFFICULT have these problems made it for you to do your work, take care of things at home, or get along with other people?

References:

Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validity and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA, 282(18), 1737–1744.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325.