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PHQ-9
(0)
PHQ-9
Name*
Date of Birth
1. Little interest or pleasure in doing things:*
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Feeling down, depressed, or hopeless:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Trouble falling or staying asleep, or sleeping too much:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Feeling tired or having little energy:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Poor appetite or overeating
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Feeling bad about yourself — or that you are a failure or have let yourself or your family down:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving .around a lot more than usual:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Thoughts that you would be better off dead or of hurting yourself in some way
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Submit
1. Little interest or pleasure in doing things:*
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Feeling down, depressed, or hopeless:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Trouble falling or staying asleep, or sleeping too much:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Feeling tired or having little energy:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Poor appetite or overeating
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Feeling bad about yourself — or that you are a failure or have let yourself or your family down:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving .around a lot more than usual:
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Thoughts that you would be better off dead or of hurting yourself in some way
0: Not at all
1: Several days
2: More than half the days
3: nearly every day
Submit
