PHQ-9 and GAD-7

Patient Health Questionnaire and General Anxiety Disorder (PHQ-9 and GAD-7)
Date

MonthDayYear
Date
Patient Name
Date of Birth

MonthDayYear
Date
PHQ-9
Over the last 2 weeks, how often have you been bothered by any of the following problems? Please O your answers

Rows	0 - Not at all	1 - Several days	2 - Over half the days	3 - Nearly every day
1. Little interest or pleasure in doing things
2. Feeling down depressed or hopeless
3. Trouble falling asleep, 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, watching television, checking emails.
8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so fidgety/ 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 in some way.

Add each Column Score (total checked x column value) = 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 AllSomewhat DifficultVery DifficultExtremely Difficult
GAD-7
Over the last 2 weeks, how often have you been bothered by any of the following problems? Please O your answers.

Rows	0 - Not at all	1 - Several days	2 - Over half the days	3 - Nearly every day
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying.
3. Worrying too much about different things.
4. Trouble relaxing.
5. Being so restless that it is hard to sit still.
6. Becoming easily annoyed or irritable.
7. Feeling afraid as if something awful might happen.

Add each Column Score (total checked x column value) = 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 AllSomewhat DifficultVery DifficultExtremely Difficult
Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute, 1999.
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Patient Health Questionnaire and General Anxiety Disorder (PHQ-9 and GAD-7)