PHQ-9 modified for Adolescents

PHQ-9 modified for Adolescents

(PHQ9-A)
Name*
Date*

MonthDayYear
Date
Instructions: How often have you been bothered by each of the following symptoms during the past two weeks? For each symptom check only one answer that most describes how you have been feeling.
1.) Feeling down, depressed, irritable, or hopeless?*

Not at allSeveral daysMore than half the daysNearly every day
2.) Little interest or pleasure in doing things?*

Not at allSeveral daysMore than half the daysNearly every day
3.) Trouble fall asleep, staying asleep, or sleeping too much?*

Not at allSeveral daysMore than half the daysNearly every day
4.) Poor appetite, weight loss, or overeating?*

Not at allSeveral daysMore than half the daysNearly every day
5.) Feeling tired, or having little energy?*

Not at allSeveral daysMore than half the daysNearly every day
6.) Feeling bad about yourself - or feeling that you are a failure, or that you have let yourself or your family down?*

Not at allSeveral daysMore than half the daysNearly every day
7.) Trouble concentrating on things like school work, reading, or watching TV?*

Not at allSeveral daysMore than half the daysNearly every day
8.) Moving or speaking so slowly that other people could have noticed?*

Not at allSeveral daysMore than half the daysNearly every day
9.) Thoughts that you would be better off dead, or of hurting yourself in some way?*

Not at allSeveral daysMore than half the daysNearly every day
In the past year have you felt depressed or sad most days, even if you felt okay sometimes?*

YesNo
If you are experiencing any of the problems on this form, 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 allSomewhat difficultVery difficultExtremely difficult
Has there been a time in the past month when you have had serious thoughts about ending your life?*

YesNo
Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt?*

YesNo
**If you have had thoughts that you would be better off dead or of hurting yourself in some way, please discuss this with your Health Care Clinician, go to a hospital emergency room or call 911.
Should be Empty: