Dr. McNeil / BrainStim TMS Depression Assessment (PHQ-9)

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Depression Assessment (PHQ-9)

For each item below, please place a check mark in the column which best describes how often you felt or behaved this way during the past several days. This assessment will be sent to Dr. McNeil for scoring and assessment.
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Name* This field is required.
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Date
Date
Month
Day
Year
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Email
example@example.com
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Phone Number
Area Code
Phone Number
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The following questionnaire consists of 9 statements. Please read each group of statements carefully, and then pick out the one statement in each group that best describes the way you have been feeling during the past two weeks, including today. If several statements in the group seem to apply equally well, select the highest number for that group.
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Over the last 2 weeks, how often have you been bothered by any of the following problems?* This field is required.
Not At All
Several Days
More than half the days
Nearly Everyday
1. Little interest or pleasure in doing things
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
2. Feeling down, depressed, or hopeless
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
3. Trouble falling or staying asleep, or sleeping too much
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
Not At All
Row 0, Column 0
Several Days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly Everyday
Row 0, Column 3
Not At All
Row 1, Column 0
Several Days
Row 1, Column 1
More than half the days
Row 1, Column 2
Nearly Everyday
Row 1, Column 3
Not At All
Row 2, Column 0
Several Days
Row 2, Column 1
More than half the days
Row 2, Column 2
Nearly Everyday
Row 2, Column 3
1 of 3
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Over the last 2 weeks, how often have you been bothered by any of the following problems?* This field is required.
Not At All
Several Days
More than half the days
Nearly Everyday
4. Feeling tired or having little energy
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
5. Poor appetite or overeating
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Not At All
Row 0, Column 0
Several Days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly Everyday
Row 0, Column 3
Not At All
Row 1, Column 0
Several Days
Row 1, Column 1
More than half the days
Row 1, Column 2
Nearly Everyday
Row 1, Column 3
Not At All
Row 2, Column 0
Several Days
Row 2, Column 1
More than half the days
Row 2, Column 2
Nearly Everyday
Row 2, Column 3
1 of 3
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Over the last 2 weeks, how often have you been bothered by any of the following problems?* This field is required.0,1,2,3
Not At All
Several Days
More than half the days
Nearly Everyday
7. Trouble concentrating on things, such as reading the newspaper or watching television
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
7. Trouble concentrating on things, such as reading the newspaper or watching television
Not At All
Row 0, Column 0
Several Days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly Everyday
Row 0, Column 3
10
Over the last 2 weeks, how often have you been bothered by any of the following problems?* This field is required.0,1,2,3
Not At All
Several Days
More than half the days
Nearly Everyday
8. 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.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
8. 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.
Not At All
Row 0, Column 0
Several Days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly Everyday
Row 0, Column 3
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Over the last 2 weeks, how often have you been bothered by any of the following problems?* This field is required.
Not At All
Several Days
More than half the days
Nearly Everyday
9. Thoughts that you would be better off dead or of hurting yourself in some way
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
9. Thoughts that you would be better off dead or of hurting yourself in some way
Not At All
Row 0, Column 0
Several Days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly Everyday
Row 0, Column 3
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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?* This field is required.
Not At All
Several Days
More than half the days
Nearly Everyday
Check One
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Check One
Not At All
Row 0, Column 0
Several Days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly Everyday
Row 0, Column 3
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Type a questionPHQ-9 Score
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