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Patient Health Questionnaire (PHQ) - For Depression
Over the last TWO WEEKS how often have you been bothered by any of the following problems?
Receive your depression assessment score and resources within 24 hours.
Ingram Screening, LLC |
www.ingramscreening.com
**This is not intended to diagnose or treat any mental health condition. Contact your provider if you are experiencing a crisis; this screening is for information purposes only**
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First & Last Name
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Your answer
State (for receiving state-specific resources)
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Your answer
Q1: Little interest of pleasure in doing things.
*
Not at all
Several Days
More than half the days
Nearly every day
Q2: Feeling down, depressed, or hopeless.
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Not at all
Several days
More than half the days
Nearly every day
Q:3 Trouble falling or staying asleep or sleeping too much.
*
Not at all
Several days
More than half the days
Nearly every day
Q4: feeling tired or having little energy.
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Not at all
Several days
More than half the days
Nearly every day
Q5: Poor appetite or overeating.
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Not at all
Several days
More than half the days
Nearly every day
Q6: Feeling bad about yourself - or that you are a failure or have let yourself or your family down.
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Not at all
Several days
More than half the days
Nearly every day
Q7: Trouble concentrating on things, such as reading the newspaper or watching television.
*
Not at all
Several days
More than half the days
Nearly every day
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.
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Not at all
Several days
More than half the days
Nearly every day
Q9: Thoughts that you would be better off dead, or of hurting yourself in some way.
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Not at all
Several days
More than half the days
Nearly every day
*If you checked off any problems, how difficult have these 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
A copy of your responses will be emailed to the address you provided.
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