PHQ-4 Improvement in Collegiate Athletes: A Clinical Outcomes Report

PHQ-4 Improvement in Collegiate Athletes: A Clinical Outcomes Report

Prepared by Onrise Mental Health | Clinical Outcomes Series

The PHQ-4 is a four-item validated screening instrument that measures the frequency and severity of anxiety and depression symptoms over a two-week period. Developed from the Patient Health Questionnaire family of tools, it combines two items from the GAD-2 anxiety subscale with two items from the PHQ-2 depression subscale. Respondents rate each item on a scale of 0 to 3, producing a total score ranging from 0 to 12. Scores of 0 to 2 indicate minimal distress, 3 to 5 indicate mild distress, 6 to 8 indicate moderate distress, and 9 to 12 indicate severe distress. The PHQ-4 is widely used in primary care and behavioral health settings because it is brief, psychometrically sound, and sensitive to change over time, making it an appropriate instrument for tracking treatment progress across a defined intervention period.

For student-athlete populations specifically, the PHQ-4 presents several practical and clinical advantages. Athletes are often time-constrained, stigma-aware, and resistant to traditional mental health intake processes perceived as lengthy or pathologizing. The PHQ-4’s brevity reduces friction in the assessment process while still generating clinically meaningful data. It captures the two symptom domains most prevalent in collegiate athletic populations — anxiety and depression — without requiring a full diagnostic evaluation. This makes it an effective universal screening and outcome-tracking tool that fits naturally within athletic department workflows without requiring dedicated clinical infrastructure for administration alone.

Onrise conducted a retrospective analysis of PHQ-4 scores among student-athletes who engaged with the Onrise platform over a 90-day period. The analysis included athletes across NCAA Division I, II, and III programs who completed both a baseline PHQ-4 assessment at program enrollment and a follow-up assessment at or near the 90-day mark. The Onrise model combines trained peer mental performance coaches — student-athletes who have undergone structured mental health and performance training — with licensed clinical providers available for escalation and direct care. This dual-tier structure ensures that athletes have access to frequent, low-barrier support alongside clinical oversight when indicated.

The primary finding of this analysis is an average PHQ-4 score reduction of 4.53 points among participating student-athletes over the 90-day engagement period. Baseline scores averaged 7.1, placing the average participant in the moderate distress range at program entry. Follow-up scores averaged 2.57, placing the same population in the minimal distress range at the 90-day mark. This shift represents a clinically significant change, not simply a statistical one. A reduction of this magnitude moves the average athlete across two scoring categories and reflects meaningful improvement in the day-to-day experience of anxiety and depression symptoms.

To contextualize this outcome, clinical benchmarks generally consider a 50 percent or greater reduction in PHQ scores to represent a treatment response, and a return to the minimal range to represent remission of meaningful symptom burden. The 4.53-point average reduction in this cohort represents approximately a 64 percent improvement from baseline, clearing the threshold for clinical response in the majority of cases analyzed. These outcomes are consistent with or exceed improvement rates reported in meta-analyses of brief psychosocial interventions delivered in college health settings, which typically report PHQ score reductions in the 2 to 3 point range over comparable timeframes.

Within the dataset, certain athlete populations demonstrated particularly strong outcomes. Freshmen and first-year transfer athletes showed the highest average improvement, likely reflecting the acute adjustment stressors that accompany early transitions into collegiate athletics. Female-identifying athletes, who entered the program with higher baseline PHQ-4 scores on average, showed substantial absolute score reductions, though male-identifying athletes showed proportionally greater percentage improvement relative to their starting point. Athletes in individual sports, including track and field, swimming, and gymnastics, demonstrated stronger outcomes than team sport athletes on average, a finding that merits further investigation but may reflect the higher rates of performance-specific anxiety reported in individual competition contexts. Revenue sport athletes — specifically those in football and basketball programs — showed meaningful improvement as well, with follow-up scores averaging in the mild range, indicating that even populations with historically lower rates of help-seeking engagement can respond positively to the peer-integrated Onrise model.

For athletic departments evaluating investments in student-athlete mental health infrastructure, this data addresses a critical and often unanswered question: does the intervention work, and can you measure whether it worked. The PHQ-4 outcome data generated through Onrise engagement provides athletic administrators, sports medicine staff, and compliance officers with a quantifiable, clinically grounded metric for demonstrating program effectiveness to stakeholders, conference leadership, and accreditation bodies. Beyond institutional accountability, the findings reflect a meaningful reduction in suffering among a population that has historically faced significant barriers to mental health care. A 4.53-point improvement in psychological distress, achieved over 90 days through a scalable peer-and-clinical model, represents both a sound clinical outcome and a compelling case for systematic investment in athlete mental health at the program level.