Patient Health Questionnaire (Phq-9)
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1Patient Health Questionnaire (PHQ-9)
Name:____________________________________________________ Date: ___________________________
DOB:______________________
Over the past 2 weeks, how often have you been
More Than
Nearly
bothered by any of the following problems?
(use “✓” to indicate your answer)
Not at all
Several
Half the
Every
l
ays
s
y
t atal
erald
an
a
ay
Days
Days
d
Day
y
th
he
d
No
ev
y
l
r
e
t
r
f
r
S
o
l
ea ve
a
M
h
N
e
1.
Little interest or pleasure in doing things
0
1
2
3
Feeling down, depressed, or hopeless
2.
0
1
2
3
Trouble falling or staying asleep,
3.
0
1
2
3
or sleeping too much
4.
Feeling tired or having little energy
0
1
2
3
5.
Poor appetite or overeating
0
1
2
3
6.
Feeling bad about yourself — or that
you are a failure or have let yourself
0
1
2
3
or your family down
7.
Trouble concentrating on things, such as
0
1
2
3
reading the newspaper or watching television
8.
Moving or speaking so slowly that other people
could have noticed. Or the opposite — being so
0
1
2
3
fidgety or restless that you have been moving
around a lot more than usual
9.
Thoughts that you would be better off dead,
0
1
2
3
or of hurting yourself in some way
add columns:
+
+
(Healthcare professional: For interpretation of TOTAL, please refer to
Total:
accompanying scoring card.)
10.
If you checked offanyproblems, how
Not difficult at all
_______
difficult have these problems made it for
Somewhat difficult _______
you to do your work, take care of things at
home, or get along with other people?
Very difficult
_______
Extremely difficult _______
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Parent category: Medical