PHQ-9

PHQ-9

Patient Health Questionnaire
Today's Date *

Month Day Year
Date
Patient Name *

First Name Last Name

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

	Not at all - 0	Several days - 1	More than half the days - 2	Nearly every day - 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
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself, that you are a failure, or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
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
9. Thoughts that you would be better off dead, or of hurting yourself

Score for each column:

	Not at all sure - 0	Several days - 1	Over half the days - 2	Nearly every day - 3
Scores:

Total Score:
If you checked off any problems, how difficult have these 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
Copyright ©1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD© is a trademark of Pfizer Inc. A2663B 10-04-2005
Provider Notes:
Should be Empty: