PHQ-9.MAT

1

Name* This field is required.

First Name

Last Name

2

UniqueID* This field is required.

3

Patient Email

example@example.com

4

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

5

Little interest or pleasure in doing things* This field is required.

Not at all

Several days

More than half the days

Nearly every day

6

Feeling down, depressed, or hopeless* This field is required.

Not at all

Several days

More than half the days

Nearly every day

7

Trouble falling or staying asleep, or sleeping too much* This field is required.

Not at all

Several days

More than half the days

Nearly every day

8

Feeling tired or having little energy* This field is required.

Not at all

Several days

More than half the days

Nearly every day

9

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

10

Poor appetite or overeating* This field is required.

Not at all

Several days

More than half the days

Nearly every day

11

Feeling bad about yourself -- or that you are a failure or have let yourself or your family down* This field is required.

Not at all

Several days

More than half the days

Nearly every day

12

Trouble concentrating on things, such as reading the newspaper or watching television* This field is required.

Not at all

Several days

More than half the days

Nearly every day

13

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.* This field is required.

Not at all

Several days

More than half the days

Nearly every day

14

Thoughts that you would be better off dead or hurting yourself in some way* This field is required.

Not at all

Several days

More than half the days

Nearly every day

15

Today's Provider* This field is required.

16

Test

17

Date

18

PHQ-9 ScorePHQ9: >9 is positive; >15 is severe

19

Grading

20

ALERT