Brief Patient Health Questionnaire (Brief PHQ)

Abstract

The Brief Patient Health Questionnaire (Brief PHQ) is a streamlined, self-report screening tool meticulously developed for efficient use in primary care settings. Its core function is to allow healthcare professionals to rapidly screen patients for common mental health conditions, most notably Major depressive disorder (MDD) and various panic or anxiety symptoms.

This instrument extends beyond simple symptom tracking by assessing crucial psychosocial stressors, functional impairment, and somatic complaints. The Brief PHQ is an expanded version of the highly validated nine-item depression scale, the PHQ-9, thereby offering a comprehensive yet quick initial mental health assessment.

Keywords

Brief PHQ, PHQ-9, depression screening, anxiety attack, primary care, psychological assessment, somatic symptoms, functional impairment, Kurt Kroenke, psychometrics.

Authors

Dr. Robert L. Spitzer, Dr. Janet B.W. Williams, Dr. Kurt Kroenke, and colleagues.

Purpose

The primary aim of the Brief PHQ is to overcome barriers to mental health screening in fast-paced clinical environments. By standardizing the patient self-report process, the instrument enables clinicians in settings like primary care to quickly gather actionable data concerning depressive, anxious, and somatic symptom frequency over a typical two-week recall window.

A key strength of the Brief PHQ is its holistic scope. It not only quantifies the severity of symptoms but also rigorously assesses the degree of functional impairment across major life domains, such as occupational performance, home responsibilities, and social interactions. Furthermore, the questionnaire incorporates essential screening elements for significant life stressors, potential trauma, and a history of physical abuse, providing a robust overview of the patient’s immediate and historical psychological and social context.

Construct

The Brief PHQ is a multi-dimensional measure designed to capture several related psychological and somatic constructs relevant to common mental disorders. The foundational element is the severity of depressive symptomatology, which is assessed via the nine items derived directly from the diagnostic criteria for Major depressive disorder (MDD).

Beyond depression, the scale actively measures acute panic and anxiety symptoms. Crucially, it incorporates metrics for assessing functional status and the perceived impact of recent and historical psychosocial stressors. These include interpersonal difficulties, financial concerns, and previous traumatic experiences, allowing for a broader diagnostic consideration beyond a single disorder.

Validity

The validity of the Brief PHQ is largely established through the extensive validation of the broader Patient Health Questionnaire (PHQ) framework. Criterion and concurrent validity studies have consistently shown that scores on the PHQ-9 subset align strongly with formal diagnoses derived from structured clinical interviews, confirming its utility as a reliable diagnostic aid in clinical practice.

Specifically, the PHQ-9 demonstrates robust criterion validity for identifying clinically significant MDD within primary care populations, often matching the performance of much longer diagnostic tools. Clinical cutoffs are well-defined: scores of 15 or greater are highly indicative of major depression, suggesting moderate to severe symptom presentation requiring clinical follow-up.

Reliability

The internal consistency reliability reported for the scale focuses on the 9-item depression subscale (PHQ-9). In a cohort of 344 subjects specifically diagnosed with diabetes, the scale exhibited excellent internal consistency, demonstrating that its items reliably measure the underlying construct of depression severity. The key psychometrics for this subscale are:

• Number of Items (PHQ-9): 9
• Observed Score Range: 0–23
• Mean Score: 6.40
• Standard Deviation: 5.73
• Internal Consistency (Alpha): 0.88
• Test-Retest Reliability: Not Available (NA)

The high internal consistency value (Alpha = 0.88) confirms the strong correlation between the nine depression items. While this data confirms the reliability of the core depression component, specific test-retest reliability figures for this particular sample were not provided in the source documentation.

Factor Analysis

Explicit factor analysis results for the full Brief PHQ were not detailed in the original source material. However, extensive academic research concerning the PHQ-9 component consistently supports a predominantly unidimensional factor structure, confirming that these nine items are coherent indicators of a single underlying construct: the severity of depressive symptomatology, aligning with DSM criteria.

Given that the comprehensive Brief PHQ includes distinct sections dedicated to anxiety, somatic complaints, and psychosocial stressors, the entire instrument is structurally designed to be multi-factorial, capturing the diverse range of mental health issues encountered in a general clinical population.

Instrument

Test Type: Self-report screening questionnaire for common mental disorders and psychosocial distress.

Format: Available in both paper-and-pencil and digital formats. Response options utilize a 4-point Likert scale (for the depression items) and dichotomous (Yes/No) options for most supplementary screening questions.

Language Available: English (Original), with extensive translations available globally due to its widespread clinical use.

Population Group: General adult population seeking routine care in clinical or primary care settings.

Age Group: Adults (Typically 18 years and older, though specific minimum age is not provided).

Population Details: The specific psychometric data cited was derived from a validation study involving 344 subjects who had been diagnosed with diabetes.

Test Methodology: Patients are instructed to rate the frequency of specific symptoms over the preceding two weeks. Scoring for the PHQ-9 subscale is achieved by summing item scores (ranging from 0 to 3). Clinical interpretation requires specific thresholds: scores of 15 or greater suggest major depression, while scores of 20 or more indicate severe major depression.

Keywords

Mental health screening, psychological assessment, Kurt Kroenke, psychometrics, self-management, functional status, somatic symptoms, PRIME-MD.

Authors

Author ORCID Identifier: Not provided in the source material.

Affiliation Email addresses: Research information contact: Dr. Spitzer at [email protected].

Correspondence Address: Not provided in the source material.

Permissions & Fee and Test Year

The Brief PHQ was initially developed in 1999, supported by an educational grant from Pfizer Inc. A significant feature of the scale is its accessibility: the source material explicitly confirms that “No permission required to reproduce, translate, display or distribute” the scale. Consequently, the Brief PHQ and its components (like the PHQ-9) are freely available for clinical, educational, and research applications, eliminating licensing fees.

The original PDF for the comprehensive Brief PHQ can be downloaded here: http://www.healthplus-ny.org/data/bh_phq.pdf

An additional resource related to the PHQ is available here: http://patienteducation.stanford.edu/research/phq.pdf

Reference’s

The scale was collaboratively developed by Drs. Robert L. Spitzer, Janet B. W. Williams, Kurt Kroenke, and their colleagues. The development suite is associated with key trademarks including PRIME-MD® and PRIME-MD TODAY® (trademarks of Pfizer Inc.).

• Spitzer, R. L., Williams, J. B. W., Kroenke, K., et al. (1999). Developed with an educational grant from Pfizer Inc. (TX221I99G © 1999, Pfizer Inc).
• English-language Diabetes Self-Management Study (This study served as the source for the PHQ-9 psychometric data, though it was unpublished at the time of the original document creation).

Items of the Brief Patient Health Questionnaire (Brief PHQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This questionnaire is an important part of providing you with the best health care possible. Your answers will help in understanding problems that you may have. Please answer every question to the best of your ability unless you are requested to skip a question.

Name Age Sex: □ Female □ Male Today’s Date

1	Over the last 2 weeks‚ how often have you been bothered by any of the following problems?
	a. Little interest or pleasure in doing things	Not at all	Several days	More than half the days	Nearly every day
	b. Feeling down‚ depressed‚ or hopeless
	c. Trouble falling or staying asleep‚ or sleeping too much
	d. Feeling tired or ha‎ving little energy
	e. Poor appetite or overeating
	f. Feeling bad about yourself‚ or that you are a failure‚ or have let yourself or your family down
	g. Trouble concentrating on things‚ such as reading the newspaper or watching television
	h. 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
	i. Thoughts that you would be better off dead‚ or of hurting yourself in some way

2. Questions about anxiety	NO	YES
a. In the last 4 weeks‚ have you had an anxiety attack suddenly feeling fear or panic? If you checked “NO‚” go to question 3.
b. Has this ever happened before?
c. 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?
d. Do these attacks bother you a lot or are you worried about ha‎ving another attack?
e. During your last bad anxiety attack‚ did you have symptoms like shortness of breath‚ sweating‚ your heart racing or pounding‚ dizziness or faintness‚ tingling or numbness‚ or nausea or upset stomach?

3. If you checked off any problems on this questionnaire so far‚ 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?

□ Not difficult at all □ Somewhat difficult □ Very difficult □ Extremely difficult

4. In the last 4 weeks‚ how much have you been bothered by any of the following problems?	Not bothered	Bothered a little	Bothered a lot
a. Worrying about your health
b. Your weight or how you look
c. Little or no sexual desire or pleasure during sex
d. Difficulties with husband/wife‚ partner/lover‚ or boyfriend/girlfriend
e. The stress of taking care of children‚ parents‚ or other family members
f. Stress at work outside of the home or at school
g. Financial problems or worries
h. ha‎ving no one to turn to when you have a problem
i. Something bad that happened recently
j. Thinking or dreaming about something terrible that happened to you in the past—like your house being destroyed‚ a severe accident‚ being hit or assaulted‚ or being forced to commit a sexual act

5. In the last year‚ have you been hit‚ slapped‚ kicked‚ or otherwise physically hurt by someone‚ or has anyone forced you to have an unwanted sexual act?

NO

YES

6. What is the most stressful thing in your life right now? -‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-

7. Are you taking any medication for anxiety‚ depression‚ or stress?

NO

YES

8. FOR WOMEN ONLY: Questions about menstruation‚ pregnancy‚ and childbirth.

a. Which best describes your menstrual periods?
Periods are unchanged
No periods because pregnant or recently gave birth
Periods have become irregular or changed in frequency‚ duration‚ or amount
No periods for at least a year
ha‎ving periods because taking hormone replacement (estrogen) therapy or oral contraceptives

b. During the week before your period starts‚ do you have a serious problem with your mood—like depression‚ anxiety‚ irritability‚ anger‚ or mood swings?

NO

YES

NO (or does not apply)

c. If YES‚ do these problems go away by the end of your period?	NO	YES
d. Have you given birth within the last 6 months?	NO	YES
e. Have you had a miscarriage within the last 6 months?	NO	YES
f. Are you ha‎ving difficulty getting pregnant?	NO	YES