Phq-9 Parent Report
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1PHQ-9 Parent Report
Child:________________________ Rater:________________________ Date:_____________
(0)
(1)
(2)
(3)
How often has your child been bothered by each of the
Not at
Several
More
Nearly
following symptoms during the past 2 weeks . For
All
Days
than Half
Every
each symptom, put an " X " in the box beneath the
the Days
Day
answer that bests describes how your child has been
feeling.
1 Feeling down, depressed, irritable or hopeless?
0
1
2
3
2 Little interest or pleasure in doing things?
0
1
2
3
Trouble falling asleep, staying asleep, or sleeping
3
0
1
2
3
too much?
4 Poor appetite, weight loss, or over-eating?
0
1
2
3
5 Feeling tired, or having little energy?
0
1
2
3
Feeling bad about him/herself - feeling like a failure,
6
0
1
2
3
or that he/she has let him/herself or the family
down?
Trouble concentrating on things like school work,
7
0
1
2
3
reading, or watching TV?
8 Moving or speaking so slowly that other people
could have noticed?
0
1
2
3
...Or the opposite-- being so fidgety or restless that
he/she was moving around a lot more than usual?
Thoughts that he/she would be better off dead, or of
9
0
1
2
3
hurting him/herself in some way?
In the past yea r, has he/she felt depressed or sad most days, even if he/she felt okay
10
sometimes?
[ ] Yes
[ ] No
If he/she is experiencing any of the problems on this form, how difficult have these problems
11
made it for him/her to do work, take care of things at home, or get along with other people?
[ ] Not difficult at all
[ ] Somewhat difficult
[ ] Very Difficult
[ ] Extremely Difficult
Has there been a time in the past month when he/she has had serious thoughts about
12
ending his/her life?
[ ] Yes
[ ] No
Has he/she EVER, in his/her WHOLE LIFE, tried to kill him/herself or made a suicide attempt?
13
[ ] Yes
[ ] No
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