Patient Health Questionnaire (PHQ-9)

Patient Health Questionnaire (PHQ-9)
Today's Date

MonthDayYear
ID #
Patient Name
Date of Birth

MonthDayYear
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things

Not at allSeveral DaysMore than half the daysNearly every day
Feeling down, depressed, or hopeless

Not at allSeveral DaysMore than half the daysNearly every day
Trouble falling or staying asleep, or sleeping too much

Not at allSeveral DaysMore than half the daysNearly every day
Feeling tired or having little energy

Not at allSeveral DaysMore than half the daysNearly every day
Poor appetite or overeating

Not at allSeveral DaysMore than half the daysNearly every day
Feeling bad about yourself - or that you are a failure or have let yourself or your family down

Not at allSeveral DaysMore than half the daysNearly every day
Trouble concentrating on things, such as reading the newspaper or watching television

Not at allSeveral DaysMore than half the daysNearly every day
Moving or speaking so slowly that other people could have noticed. Or the opposite being so figety or restless that you have been moving around a lot more than usual

Not at allSeveral DaysMore than half the daysNearly every day
Thoughts that you would be better off dead, or of hurting yourself

Not at allSeveral DaysMore than half the daysNearly every day
Total Score
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 allSome what difficultVery difficultExtremely difficult
Should be Empty: