Patient Depression Questionnaire (PHQ-9) Patient Depression Questionnaire (PHQ-9) Patient Depression Questionnaire (PHQ-9) Patient ID: Date * Patient Name * Patient Name First First Last Last Over the last 2 weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing things * Please select oneNot at all (0)Several days (1)More than half the days (2)Nearly every day (3) 2. Feeling down, depressed, or hopeless * Please select oneNot at all (0)Several days (1)More than half the days (2)Nearly every day (3) 3. Trouble falling or staying asleep, or sleeping to much * Please select oneNot at all (0)Several days (1)More than half the days (2)Nearly every day (3) 4. Feeling tired or having little energy * Please select oneNot at all (0)Several days (1)More than half the days (2)Nearly every day (3) 5. Poor appetite or overeating * Please select oneNot 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 * Please select oneNot at all (0)Several days (1)More than half the days (2)Nearly every day (3) 7. Trouble concentrating or things, such as reading the newspaper or watching television * Please select oneNot 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 notice, or the opposite (moving a lot more that normal) * Please select oneNot 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 * Please select oneNot at all (0)Several days (1)More than half the days (2)Nearly every day (3) Scare: 0-4 Minimal or non Monitor; may not require treatment 5-9 Mild 10-14 Moderate (Use clinical judgment {symptom duration, functional impairment} to determine necessity of treatment) 15-19 Moderate severe 20-27 Severe (Warrants active treatment with psychotherapy, medications, or combination) CRITICAL ACTIONS: Perform suicide risk assessment in patients who respond positively to item 9 “Thoughts that you would be better off dead or of hurting yourself in some way.” Rule out bipolar disorder, normal bereavement, and medical disorders causing depression. * 121234567891011 : 0030 AMPM Time If you are human, leave this field blank. Submit Start Over