PHQ-9 (Patient Health Questionnaire-9)

This is your form description. Click here to edit.

Name Name * First Last
Account Number *

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	Little interest or pleasure in doing thingsNot at all (0)	Little interest or pleasure in doing thingsSeveral Days (1)	Little interest or pleasure in doing thingsMore than Half the Days (2)	Little interest or pleasure in doing thingsNearly Every Day (3)
Feeling down, depressed, or hopeless	Feeling down, depressed, or hopelessNot at all (0)	Feeling down, depressed, or hopelessSeveral Days (1)	Feeling down, depressed, or hopelessMore than Half the Days (2)	Feeling down, depressed, or hopelessNearly Every Day (3)
Trouble falling or staying asleep, or sleeping too much	Trouble falling or staying asleep, or sleeping too muchNot at all (0)	Trouble falling or staying asleep, or sleeping too muchSeveral Days (1)	Trouble falling or staying asleep, or sleeping too muchMore than Half the Days (2)	Trouble falling or staying asleep, or sleeping too muchNearly Every Day (3)
Feeling tired or having little energy	Feeling tired or having little energyNot at all (0)	Feeling tired or having little energySeveral Days (1)	Feeling tired or having little energyMore than Half the Days (2)	Feeling tired or having little energyNearly Every Day (3)
Poor appetite or overeating	Poor appetite or overeatingNot at all (0)	Poor appetite or overeatingSeveral Days (1)	Poor appetite or overeatingMore than Half the Days (2)	Poor appetite or overeatingNearly Every Day (3)
Feeling bad about yourself- or that you are a failure or have let yourself or your family down	Feeling bad about yourself- or that you are a failure or have let yourself or your family downNot at all (0)	Feeling bad about yourself- or that you are a failure or have let yourself or your family downSeveral Days (1)	Feeling bad about yourself- or that you are a failure or have let yourself or your family downMore than Half the Days (2)	Feeling bad about yourself- or that you are a failure or have let yourself or your family downNearly Every Day (3)
Trouble concentrating on things, such as reading the newspaper or watching television	Trouble concentrating on things, such as reading the newspaper or watching televisionNot at all (0)	Trouble concentrating on things, such as reading the newspaper or watching televisionSeveral Days (1)	Trouble concentrating on things, such as reading the newspaper or watching televisionMore than Half the Days (2)	Trouble concentrating on things, such as reading the newspaper or watching televisionNearly Every Day (3)
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	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 usualNot at all (0)	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 usualSeveral Days (1)	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 usualMore than Half the Days (2)	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 usualNearly Every Day (3)
Thoughts that you would be better off dead, or of hurting yourself	Thoughts that you would be better off dead, or of hurting yourselfNot at all (0)	Thoughts that you would be better off dead, or of hurting yourselfSeveral Days (1)	Thoughts that you would be better off dead, or of hurting yourselfMore than Half the Days (2)	Thoughts that you would be better off dead, or of hurting yourselfNearly Every Day (3)

How difficult have these problems made it to do work, take care of things at home, or get along with other people? *

How difficult have these problems made it to do work, take care of things at home, or get along with other people? Not at all Somewhat difficult Very difficult Extremely difficult