Limitations of PHQ-9 as a first line mental health screener in primary care.
- 1Sapien Labs, Arlington, VA, United States.
- 2Sapien Labs Center for Human Brain and Mind at Krea, IFMR, Chennai, India.
- 3Department of Psychiatry, University of California San Diego, La Jolla, La Jolla, CA, United States.
Abstract
Background
The PHQ-9, originally designed as an assessment for depression, is now widely used as a first line screener in primary care and is often the sole mental health screener used. However, it is currently unknown how well the PHQ-9 performs as a general screener for mental distress. Here we aim to determine the sensitivity and specificity of the (PHQ-9) for capturing general or transdiagnostic mental distress, defined as experiencing 5 or more severe mental health symptoms.Methods
PHQ-9 responses were collected alongside responses to the transdiagnostic Mental Health Quotient (MHQ) assessment that captures 47 symptoms spanning 10 disorders as well as additional elements from RDoC in a sample of 5,750 respondents collected in 2022. PHQ-9 sum scores were compared with those with 5 or more symptoms from the MHQ.Results
At a sum score cut-off corresponding to moderately severe depression, PHQ-9 had low sensitivity, capturing only 46% of those with general mental distress. At a cut-off corresponding to mild depression, sensitivity improved to 93%, while specificity dropped to 57%. Concurrently, the PHQ-9 missed several symptoms that were highly prevalent in the sample population and individuals with Severe PHQ-9 sum scores showed substantial heterogeneity in their overall symptom profiles.Conclusions
Altogether, the PHQ-9, due to its origin as a depression screener, is not appropriate as a screener for general mental distress. In the context of primary care triage, this highlights the need for an alternative disorder agnostic first line screener that enables the identification of severe mental distress regardless of the specific profile of symptoms.
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BibTeX
@article{newson2026limitations,
title = {{Limitations of PHQ-9 as a first line mental health screener in primary care.}},
author = {Jennifer Jane Newson and Dhanya Parameshwaran and Jason Schweitzer and Tara C Thiagarajan},
journal = {Frontiers in psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1823578},
url = {https://europepmc.org/article/MED/42903343},
note = {CC BY},
}
RIS
TY - JOUR
TI - Limitations of PHQ-9 as a first line mental health screener in primary care.
AU - Jennifer Jane Newson
AU - Dhanya Parameshwaran
AU - Jason Schweitzer
AU - Tara C Thiagarajan
PY - 2026
DA - 2026/10/06
JO - Frontiers in psychiatry
DO - 10.3389/fpsyt.2026.1823578
UR - https://europepmc.org/article/MED/42903343
AB - Background The PHQ-9, originally designed as an assessment for depression, is now widely used as a first line screener in primary care and is often the sole mental health screener used. However, it is currently unknown how well the PHQ-9 performs as a general screener for mental distress. Here we aim to determine the sensitivity and specificity of the (PHQ-9) for capturing general or transdiagnostic mental distress, defined as experiencing 5 or more severe mental health symptoms.Methods PHQ-9 responses were collected alongside responses to the transdiagnostic Mental Health Quotient (MHQ) assessment that captures 47 symptoms spanning 10 disorders as well as additional elements from RDoC in a sample of 5,750 respondents collected in 2022. PHQ-9 sum scores were compared with those with 5 or more symptoms from the MHQ.Results At a sum score cut-off corresponding to moderately severe depression, PHQ-9 had low sensitivity, capturing only 46% of those with general mental distress. At a cut-off corresponding to mild depression, sensitivity improved to 93%, while specificity dropped to 57%. Concurrently, the PHQ-9 missed several symptoms that were highly prevalent in the sample population and individuals with Severe PHQ-9 sum scores showed substantial heterogeneity in their overall symptom profiles.Conclusions Altogether, the PHQ-9, due to its origin as a depression screener, is not appropriate as a screener for general mental distress. In the context of primary care triage, this highlights the need for an alternative disorder agnostic first line screener that enables the identification of severe mental distress regardless of the specific profile of symptoms.
SN - 1664-0640
ER -