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PHQ - 9: Patient Health Questionnaire
How often have you noticed the following challenges
over the last two weeks
?
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Full Name:
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Your answer
Mobile Number:
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Your answer
1. In
the last 2 weeks, I have noticed
that I have had little interest or pleasure in doing the things I used to enjoy
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
2.
In
the last 2 weeks, I have noticed
that I have
I felt down, depressed, or hopeless when facing challenging situations
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
3.
In
the last 2 weeks, I have noticed
that
I have had trouble falling or staying asleep,
OR
sleeping too much
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
4.
In
the last 2 weeks, I have noticed
that I have
felt tired
OR
have little to no energy to carry out my daily tasks
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
5.
In
the last 2 weeks, I have noticed
that
I have a poor appetite
OR
I have a tendency to overeat when facing challenging situations
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
6.
In
the last 2 weeks, I have noticed
that I have
felt bad about myself
OR
that I am a failure
OR
have let myself or my family down
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
7.
In
the last 2 weeks, I have noticed
that
I have had trouble concentrating on things such as reading the newspaper
OR
watching television
OR
completing a task
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
8.
In
the last 2 weeks, I have noticed
that
I have been moving or speaking so slow that other people around me have noticed it
OR
I have been so fidgety or restless that I have been moving around a lot more than usual
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
9.
In
the last 2 weeks, I have noticed
that
I think I would be better off dead
OR
hurting myself in some way
*
0 - Not at all 1 - Several days a week 2 - More than half the days in a week 3 - Nearly everyday
Not at all
0
1
2
3
Nearly everyday
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