PHQ-9 - Depression Assessment

Name

Date

Over the last 2 weeks, how often have you been bothered by any of the following problems? (select one answer for each problem)	Not at all	Several days	More than half the days	Nearly every day
1. Little interest or pleasure in doing things	0	1	2	3
2. Feeling down, depressed, or hopeless	0	1	2	3
3. Trouble falling or staying asleep, or sleeping too much	0	1	2	3
4. Feeling tired or having little energy	0	1	2	3
5. Poor appetite or overeating	0	1	2	3
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down	0	1	2	3
7. Trouble concentrating on things, such as reading the newspaper or watching television	0	1	2	3
8. 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	0	1	2	3
9. Thoughts that you would be better off dead, or of hurting yourself	0	1	2	3
add columns
(Healthcare professional: For interpretation of TOTAL, please refer to accompanying scoring card). TOTAL:

10. If you checked off any problems, 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?

Not difficult at all Somewhat difficult Very difficult Extremely difficult

If you are having thoughts of hurting yourself, you don't have to wait for your appointment.
Call or text 988 (Suicide & Crisis Lifeline) any time, day or night. If you are in immediate danger, call 911 or go to the nearest emergency room.

Copyright © 1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIME-MD© is a trademark of Pfizer Inc.
A2663B 10-04-2005

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PHQ9 | Patient details and clinician review

Patient name

Date

DOB

MRN

Score / interpretation (entered manually)

Total Score

Interpretation

Review the supplied instrument instructions before scoring

Clinician Name

Review date

Follow-up/Notes