PATIENT HEALTH QUESTIONNAIRE-9(PHQ-9)
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Over the last 2 weeks, how often have you been bothered by any of the following problems?(Use “✔” to indicate your answer)
1. Feeling nervous, anxious or on edge
*
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 — or 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 havenoticed? Or the opposite — being so fidgety or restlessthat you have been moving around a lot more than usual
*
9. Thoughts that you would be better off dead or of hurtingyourself in some way
*
If you checked off any problems, how difficult have these problems made it for you to do yourwork, take care of things at home, or get along with other people?
*
Total
Submit
Should be Empty: