Depression Screening – Patient Health Questionnaire (PHQ-9)

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PHQ-9 Assessment Form
A. 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)
Q1. Little interest or pleasure in doing things
Q2. Feeling down, depressed, or hopeless
Q3. Trouble falling or staying asleep, or sleeping too much
Q4. Feeling tired or having little energy
Q5. Poor appetite or overeating
Q6. Feeling bad about yourself or that you are a failure or have let yourself or your family down
Q7. Trouble concentrating on things, such as reading the newspaper or watching television
Q8. 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
Q9. Thoughts that you would be better off dead, or of hurting yourself in some way
B. 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? Not difficult at all Somewhat difficult Very difficult Extremely difficult
Score Action
0-4 The score suggests the patient may not need depression treatment
5-14 Mild major depressive disorder. Physician uses clinical judgement about treatment, based on patient’s duration of symptoms and functional impairment
15-19 Moderate major depressive disorder. Warrants treatment for depression, using antidepressant, psychotherapy or a combination of treatment
20 or higher Severe major depressive disorder. Warrants treatment with antidepressant, with or without psychotherapy; follow frequently

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