Patient Health Questionnaire (PHQ-9)

Title

First Name

Surname

Date Of Birth

Telephone

Email Address

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

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling/staying asleep, sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself or that you are a failure or have let yourself or your family down

Trouble concentrating on things, such as reading the newspaper 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.

If you checked off any problem on this questionnaire so far, 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

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Patient Health Questionnaire (PHQ-9)

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