Patient Health Questionnaire (PHQ-9)

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Patient Health Questionnaire 9
Please complete the survey below.
Thank you!

Patient Health Questionnaire 9 (PHQ-9)
Date:
__________________________________
First Name
__________________________________
Last Name
__________________________________

Over the last 2 weeks how often have you been bothered by any of the following problems?
(Click the circle to indicate your answer)
1. Little interest or pleasure in doing things
0- Not at all

1- Several days

2- More than half the days

3- Nearly every day

2- More than half the days

3- Nearly every day

2. Feeling down, depressed, or hopeless
0- Not at all

1- Several days

3. Trouble falling or staying asleep, or sleeping too much
0- Not at all

1- Several days

2- More than half the days

3- Nearly every day

2- More than half the days

3- Nearly every day

2- More than half the days

3- Nearly every day

4. Feeling tired or having little energy
0- Not at all

1- Several days

5. Poor appetite or overeating
0- Not at all

1- Several days

6. Feeling bad about yourself -- or that you are a failure or have let yourself or your family down
0- Not at all

1- Several days

2- More than half the days

3- Nearly every day

7. Trouble concentrating on things, such as reading the newspaper or watching television
0- Not at all

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1- Several days

2- More than half the days

3- Nearly every day

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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
0- Not at all

1- Several days

2- More than half the days

3- Nearly every day

9. Thoughts that you would be better off dead or of hurting yourself in some way
0- Not at all

1- Several days

2- More than half the days

Total Score:

3- Nearly every day

__________________________________

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?
1- Not difficult at all

2- Somewhat difficult

3- Very difficult

4- Extremely difficult

Scoring:
Nine items, each of which is scored 0 to 3, providing a 0 to 27 severity score.
Severity:
Score, Depression Severity, Proposed Treatment Actions
0 - 4 None-minimal, None
5 - 9 Mild, Watchful waiting; repeat PHQ-9 at follow-up
10 - 14 Moderate, Treatment plan, considering counseling, follow-up and/or pharmacotherapy
15 - 19 Moderately Severe, Active treatment with pharmacotherapy and/or psychotherapy
20 - 27 Severe, Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy,
expedited referral to a mental health specialist for psychotherapy and/or collaborative management

Kroenke K, Spitzer RL, Williams JB.The PHQ-9: Validity of a Brief Depression Severity Measure. J Gen Intern Med. 2001
September; 16(9): 606-613.

08/27/2021 3:09pm

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