Mental Health Questionnaire

Mental Health Questionnaire
Depression Screening Tool (PHQ-9)

Over the last 2 weeks, how often have you been bothered by any of the following problems?*

	Not at all	Several Days	More than half the days	Nearly every day
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 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 of hurting yourself in some way.

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
General Anxiety Disorder Screening Tool (GAD-7)

Over the last 2 weeks, how often have you been bothered by any of the following problems?*

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

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

Screening Results

This is not intended for diagnostic purposes, only a behavioral health professional can diagnose you with a clinical diagnosis. This is for information purposes only, and does not substitute for professional mental health advice.
Depression Screening Results

Total Score	Depression Severity
0-4	None
5-9	Mild
10-14	Moderate
15-19	Moderately Severe
20-27	Severe

(PHQ-9) Difficulty level when doing your work, taking care of things at home, or getting along with other people:
General Anxiety Disorder Screening Results

Total Score	Interpretation
≥ 10	Probable diagnosis of GAD; confirm by further evalutation
5	Mild anxiety
10	Moderate anxiety
15	Severe anxiety

(GAD-7) Difficulty level when doing your work, taking care of things at home, or getting along with other people:
If you would like to talk more about your results of this screening please contact Otero College's Mental Health Counselor:

Dänya Herrell
(719) 384-6945
danya.herrell@otero.edu
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