PHQ-2 SCREEN

Date: [Date]
Patient: [Name or chart number, age]
Setting: [Annual visit, new patient visit, prenatal visit, pharmacy, or other]
Format: [Paper, tablet, or read aloud word for word; language and interpreter if used]

SCREEN
Item 1, little interest or pleasure: [0 to 3]
Item 2, feeling down, depressed, or hopeless: [0 to 3]
PHQ-2 total: [0 to 6]
Result: [Negative at 0 to 2, or positive at 3 to 6; the cutoff used if not 3]

FOLLOW-UP
Full PHQ-9: [Given the same visit with total, band, and item 9 score; or not needed]
Self-harm: [Asked directly or through item 9, and what the patient said]

CONTEXT
What else is going on: [Recent losses, stress, illness, pregnancy, new medicines]
Past depression: [Earlier episodes and treatment, or none]

DECISION
Next step: [Interview and plan today, referral, or nothing further on a negative screen]
Rescreen: [Next annual visit, next trimester, or a set date]
Discussed with patient: [What they were told, and when to come back sooner]

Screened by: [Name, role]