Patient Health Questionnaire - 9 (PHQ

Name*

First NameLast Name

Email*

example@example.com

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

0 - Not at all | 1 - Several Days | 2 - More than half the days | 3 - Nearly every day

Little interest or pleasure in doing things*

Feeling down, depressed, or hopeless*

Trouble falling or staying asleep, too much*

Poor appetite or overeating*

Feeling bad about yourself - or that a failure or have let yourself or your family down*

Trouble concentrating on things, such as reading 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*

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?*

Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer inc. No permission is required to reproduce, translate, display, or distribute.

Patient Health Questionnaire - 9 (PHQ - 9)