Patient Health Questionnaire (PHQ-9)

Name*

First NameLast Name

Date of Birth*

Date

Over the LAST 2 WEEKS, how often have you been bothered by any of the following problems:

	Not at all (0)	Several days (1)	More than half the days (2)	Nearly every day (3)
Little interest or pleasure in doing things
Feeling down, depressed or hopeless
Trouble falling or staying asleep or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself...or that you are a failure or that you have let yourself or your family down
Trouble concentrating on things; such as reading the newspaper or watching television
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
Thoughts that you would be better off dead or hurting yourself

Total from Column 1

Total from Column 2

Total from Column 3

Total of all Columns

If you checked off any problems, 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

PHQ-9 Patient Depression Questionnaire

For initial diagnosis:
1. Patient completes PHQ-9 Quick Depression Assessment.
2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressivedisorder. Add score to determine severity.

Consider Major Depressive Disorder
- if there are at least 5 3s in the shaded section (one of which corresponds to Question #1 or #2)

Consider Other Depressive Disorder
- if there are 2-4 3s in the shaded section (one of which corresponds to Question #1 or #2)

Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician,
and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient.
Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social,occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms.

To monitor severity over time for newly diagnosed patients or patients in current treatment for
depression:
1. Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at
home and bring them in at their next appointment for scoring or they may complete the
questionnaire during each scheduled appointment.
2. Add up 3s by column. For every 3: Several days = 1 More than half the days = 2 Nearly every day = 3
3. Add together column scores to get a TOTAL score.
4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score.
5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of
response, as well as guiding treatment intervention.

Scoring: add up all checked boxes on PHQ-9
For every 3 Not at all = 0; Several days = 1;
More than half the days = 2; Nearly every day = 3

Interpretation of Total Score
Total Score Depression Severity
1-4 Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression
PHQ9 Copyright © Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD ® is a
trademark of Pfizer Inc.

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