Derivation of a 3-Item Patient Health Questionnaire as a Shortened Survey to Capture Depressive Symptoms

Screening measures of depressive symptoms (eg, 9-item Patient Health Questionnaire [PHQ-9]) are increasingly used in surveys and remote applications, where shorter versions would be valuable.

To derive shorter versions of the PHQ-9 that maximize the variability in total depressive symptom severity captured.

This survey study used data from 4 waves of a 50-state nonprobability web-based survey conducted between November 2, 2023, and July 21, 2024. Survey respondents were aged 18 years or older. The first survey wave data were used to identify shortened question subsets capturing variance in the PHQ-9 and estimating a PHQ-9 score of 10 or higher. Resulting models (eg, 3-item version of the PHQ [PHQ-3]) were validated in subsequent survey waves.

Performance of PHQ-3 in the full sample and across subgroups of age, gender, race and ethnicity, and educational levels. Depressive symptom severity was measured with the PHQ-9 (total score range: 0-27, with a score ≥10 indicating moderate or greater depressive symptoms).

In the 4 survey waves, there were 96 234 total participants (mean [SD] age, 47.3 [17.1] years; 55 245 [57.4%] identifying as women). In the full sample, 4401 participants (4.6%) identified as Asian American, 12 699 (13.2%) as Black or African American, 9776 (10.2%) as Hispanic or Latino, and 65 309 (67.9%) as White individuals, with 4049 (4.2%) who identified as having other race or ethnicity. Among these participants, the mean (SD) PHQ-9 score was 6.5 (6.6), and 25 411 (26.4%) met the criteria for moderate or greater depressive symptoms (PHQ-9 score ≥10). The optimal 3-item version, PHQ-3, used items 2 (subject: depressed mood), 6 (self-esteem or failure), and 1 (interest), yielding a Cronbach α of 0.88 (95% CI, 0.88-0.88) and Pearson correlation with the PHQ-9 total score of 0.93 (95% CI, 0.93-0.94). At a threshold of 3 or greater, the PHQ-3 sensitivity was 0.98 (95% CI, 0.97-0.98) and specificity was 0.76 (95% CI, 0.75-0.76) for moderate or greater depressive symptoms. Performance was consistent across sociodemographic subgroups and survey waves.

This survey study of US adults identified a 3-item scale that remained highly correlated with the full PHQ-9 instrument. The reduced set of questions could enable more widespread and efficient incorporation of depressive symptom measurement in general population samples.