THEZ07 Patient Health Questionnaire-9

Therapeutic Medical & Psychiatric Services LLC

PATIENT HEALTH QUESTIONNAIRE-9

(PHQ-9)
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Date*

MonthDayYear
Date
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?*

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
2. Feeling down, depressed, or hopeless?*

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
3. Trouble falling or staying asleep, or sleeping too much?

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
4. Feeling tired or having little energy?

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
5. Poor appetite or overeating?

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down?

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
7. Trouble concentrating on things, such as reading the newspaper or watchingtelevision?

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
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 (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
9. Thoughts that you would be better off dead, or of hurting yourself in some way?

Not at All (0)Several Days (1)More than Half the Days (2)Nearly Every Day (3)
Calculation
10. If you checked off ANY problems, how DIFFICULT have those problems made it for you to do your work, take care of things at home, or get along with other people?

Not difficult at allSomewhat difficultVery DifficultExtremely Difficult
Developed by Drs. Robert L Spitzer, Janet B. W. Williams, Kurt Kroenke and colleagues with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.
Should be Empty:

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