Personal Growth Better Quality of Life Reduced Stress Patient Health Questionnaire (PHQ-9) Date* Date Format: MM slash DD slash YYYY Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Over the past 2 weeks, have you been bothered by any of the following problems?Over the past 2 weeks, have you been bothered by any of the following problems?1. Little interest or pleasure in doing things*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day2. Feeling down, depressed, or hopeless*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day3. Trouble falling or staying asleep, or sleeping too much*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day4. Feeling tired or having little energy*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day5. Poor appetite or overeating*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day6. Feeling bad about yourself, or that you are a failure or have let yourself or your family down*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day7. Trouble concentrating on things, such as reading the newspaper or watching television*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every day8. 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 = Not at all1 = Several days2 = More than half the days3 = Nearly every day9. Thoughts that you would be better off dead, or of hurting yourself in some way*0 = Not at all1 = Several days2 = More than half the days3 = Nearly every dayIf 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 allSomewhat difficultVery difficultExtremely difficultPHQ-9 is adapted from PRIME MD TODAY, developed by Drs Robert L Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer Inc. For research information, contact Dr. Spitzer at rls8@columbia.edu. PHQ-9 Copyright © 1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIMED-MD TODAY® are trademarks of Pfizer Inc.Form CreditsPHQ-9 is adapted from PRIME MD TODAY, developed by Drs Robert L Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer Inc. For research information, contact Dr. Spitzer at rls8@columbia.edu. PHQ-9 Copyright © 1999 Pfizer Inc. All rights reserved. Reproduced with permission. PRIMED-MD TODAY® are trademarks of Pfizer Inc.NameThis field is for validation purposes and should be left unchanged.
