Patient Health Questionnaire (Page 2 of 3) in pdf

Patient Health Questionnaire Page 2

Patient Health Questionnaire (PHQ-9)

Original version

Patient Name

Date

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Not at

Several

More than

Nearly

all

days

half the days

every day

(0)

(1)

(2)

(3)

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself — or that you are a

failure or have let yourself or your family down

Trouble concentrating on things, such as reading

the newspaper or watching television

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

Thoughts that you would be better off dead or of

hurting yourself in some way

TOTAL :

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of

things at home, or get along with other people?

Not difficult at all

Somewhat difficult

Very difficult

Extremely difficult

Patient Health Questionnaire Page 2