Outcome
The HPS contains the Patient Health Questionnaire-4 (PHQ-4),
a well-established and validated screening tool for anxiety and
depression.8,13 The screener asks respondents to report the frequency
during which they felt down, worried, generally uninterested,
and anxious over the past 2weeks, as assessed by
a 4-level scale ranging from “not at all” (score, 0) to “nearly
every day” (score, 3).Responses across these 4 questionswere
aggregated to create a continuous 0 to 12 index (the standard
measure of the PHQ-4). Scores ranging from 0 to 2 represent
nosymptomsof anxietyordepression; 3 to5,mild;6to8,moderate;
and 9 to 12, severe.14 A PHQ-4 score of at least 6 typically
indicates need for clinical intervention and is associated with increased health care use, disability days, and functional
impairment.15 The minimal clinically important difference
of the PHQ-4 scale is not known.
JAMA. 2024;331(4):294-301. doi:10.1001/jama.2023.25599
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