Patient Health Questionnaire (PHQ-9)

Name *
Date of Birth *
Date of Birth
Date of Visit *
Date of Visit
Over the past 2 weeks, how often have you been bothered by any of the following problems:
1. Little interest or pleasure in doing things *
2. Feeling down, depressed, or hopeless *
3. Trouble falling or staying staying, 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 have noticed? Or the opposite- 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 *
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?