Patient Health Questionnaire-9
(PHQ-9)
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Over the last 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things
*
Not at all
Several days
More than half the days
Nearly every day
2. Feeling down, depressed, or hopeless
*
Not at all
Several days
More than half the days
Nearly every day
3. Trouble falling or staying asleep, or sleeping too much
*
Not at all
Several days
More than half the days
Nearly every day
4. Feeling tired or having little energy
*
Not at all
Several days
More than half the days
Nearly every day
5. Poor appetite or overeating
*
Not at all
Several days
More than half the days
Nearly every day
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
*
Not at all
Several days
More than half the days
Nearly every day
8. 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
*
Not at all
Several days
More than half the days
Nearly every day
9. Thoughts that you would be better off dead or of hurting yourself in some way
*
Not at all
Several days
More than half the days
Nearly every day
Total score:
If you checked off any problems, 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 all
Somewhat difficult
Very difficult
Extremely difficult
Source:
Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required o reproduce, translate, display or distribute.
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