Personal Growth Better Quality of Life Reduced Stress Patient Health Questionnaire (PHQ-9) Date* MM slash DD slash YYYY Name* First Last Date of Birth* MM slash DD slash YYYY HiddenOver 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 all 1 = Several days 2 = More than half the days 3 = Nearly every day 2. Feeling down, depressed, or hopeless* 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 3. Trouble falling or staying asleep, or sleeping too much* 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 4. Feeling tired or having little energy* 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 5. Poor appetite or overeating* 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 6. Feeling bad about yourself, or that you are a failure or have let yourself or your family down* 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 7. Trouble concentrating on things, such as reading the newspaper or watching television* 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 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 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 9. Thoughts that you would be better off dead, or of hurting yourself in some way* 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day 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 PHQ-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.HiddenForm 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.
