title: The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.
abstract: BACKGROUND
  Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable.
  
  
  METHODS
  Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales.
  
  
  RESULTS
  The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15.
  
  
  CONCLUSIONS
  The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.
authors.affiliation: Regenstrief Institute, Inc. and the Department of Medicine, Indiana University, Indianapolis, IN 46202, USA. kkroenke@regenstrief.org
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
authors.forename: Robert L
authors.initials: RL
authors.lastname: Spitzer
authors.forename: Janet B W
authors.initials: JB
authors.lastname: Williams
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D009735:Nursing Homes; D011247:Pregnancy; D011594:Psychometrics; D012680:Sensitivity and Specificity; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires / Q000592:standards