PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
This questionnaire aims to assess how your mood might be impacting day-to-day.
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Email *
DATE FORM COMPLETED *
GENDER *
AGE *
Stage form completed *
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 *
2.  Persistent low mood, feeling down, or hopeless *
3.  Trouble falling or staying asleep *
4.  Feeling tired or having little energy *
5. Poor appetite or over eating *
6. Feeling bad about self - or that you are a failure or have let yourself or your family down *
7. Trouble concentrating on things, such as reading, working or watching TV *
8.Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless causing you to move around a lot more than usual *
9. Thoughts that you would be better off dead or of hurting yourself in some way. *
PLEASE ADD UP ALL THE OPTIONS YOU HAVE SELECTED USING THE NUMBERS IN THE BRACKETS AND PUT YOUR TOTAL SCORE BELOW *
PLEASE SELECT THE APPRORIATE DISTRESS CATEGORY ACCORDING TO YOUR ANSWER ABOVE
 *
Thank you for completing this questionnaire.
Adapted for Mabadiliko Intercultural Therapy (MIT) use. 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
A copy of your responses will be emailed to the address you provided.
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