PHQ-9 Patient Health Questionnaire

PHQ-9 Patient Health Questionnaire — Depression Screen
Over the last 2 weeks, how often have you been bothered by any of the following problems? Mark your answer with a checkmark or circle.
Patient name and last name
Date of birth

MonthDayYear
Date
Date completed

MonthDayYear
Date

Over the last 2 weeks, how often have you been bothered by any of the following problems? Mark your answer with a checkmark or circle.

Rows	Not at all (0)	Several days (1)	More than half the days (2)	Nearly every day (3)
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or 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 the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed — or being so fidgety or 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

Question 10 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?
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?
PHQ-9 developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues. For research information, contact Dr. Spitzer at
ris8@columbia.edu. For clinical use, this form may be reproduced without permission.
PHQ-9 Patient Instructions
Why am I filling out this form?
This questionnaire helps your provider understand how you have been feeling emotionally over the past 2
weeks. There are no right or wrong answers. Please answer as honestly as possible.
How do I answer the questions?
For each question, think about the LAST 2 WEEKS and choose the answer that best describes how often
you experienced that problem.
Not at all (0)
- The problem did not happen during the past 2 weeks.
Several days (1)
- The problem happened occasionally (about 1–6 days).
More than half the days (2)
- The problem happened frequently (about 7–11 days).
Nearly every day (3)
- The problem happened most days or almost every day (12–14 days).
Important Tips
- Answer based on your average experience over the last 2 weeks.
- Do not spend too much time on any one question.
- If you are unsure between two answers, choose the one that feels most accurate.
- Answer every question, even if the symptom seems mild.
- This form is confidential and is used to help guide your treatment.
Question 10
After completing Questions 1–9, answer Question 10 by indicating how much these symptoms have affected your ability to:
- Work or attend school
- Take care of responsibilities at home
- Get along with family, friends, or coworkers

Choose:
Important Safety Information
For Question 9 ("Thoughts that you would be better off dead or of hurting yourself in some way"), please answer honestly. If you have experienced these thoughts, your provider will discuss them with you to help ensure your safety and provide appropriate support.
Should be Empty:

PHQ-9 Patient Health Questionnaire — Depression Screen

PHQ-9 Patient Instructions

Important Safety Information