PHQ- 9: ADULT

PHQ-9 Questionnaire

2023
Patient Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phase of Treatment*

New ClientDuring TreatmentEnd of Treatment
Today's Date*

MonthDayYear
Date
In what setting do you receive services?*

FacilityPhoenix 104Phoenix 108Phoenix 205CottonwoodTucsonLaveenTelemedicine/TeleHealth
Instructions: How often have you been bothered by each of the following symptoms during the past two weeks? For each symptom select the box beneath the answer that best describes how you have been feeling.
1. Little interest or pleasure in doing things?*

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
2. Feeling down, depressed, irritable, or hopeless?*

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
3. Trouble falling asleep, staying asleep, or sleeping too much?*

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
4. Feeling tired, or having little energy?*

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
5. Poor appetite, weight loss, or overeating?*

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
6. Feeling bad about yourself – or feeling that you are a failure, or that you have let yourself or your family down?*

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
7. Trouble concentrating on things like school work, reading, or watching TV?*

0 Not At All1 Several Days2 More Than Half The Days3 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 were moving around a lot more than usual?*

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
9. 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 Day
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 allSomewhat difficultVery DifficultExtremely Difficult
Total Score Depression Severity
Total Score Depression Severity

0-4 No or Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression
**If you have had thoughts that you would be better off dead or of hurting yourself in some way, please discuss this with your Health Care Clinician, go to a hospital emergency room or call 911.
PHQ-9 Patient Depression Questionnaire

For initial diagnosis:
1. Patient completes PHQ-9 Quick Depression Assessment.
2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive
disorder. Add score to determine severity.
Consider Major Depressive Disorder
if there are at least 5 3s in the shaded section (one of which corresponds to Question #1 or #2)
Consider Other Depressive Disorder
- if there are 2-4 3s in the shaded section (one of which corresponds to Question #1 or #2)
Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician,
and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood
the questionnaire, as well as other relevant information from the patient.
Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require impairment of social,
occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a
history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the
biological cause of the depressive symptoms.
To monitor severity over time for newly diagnosed patients or patients in current treatment for
depression:
1. Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at
home and bring them in at their next appointment for scoring or they may complete the
questionnaire during each scheduled appointment.
2. Add up 3s by column. For every 3: Several days = 1 More than half the days = 2 Nearly every day = 3
3. Add together column scores to get a TOTAL score.
4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score.
5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of
response, as well as guiding treatment intervention.
Scoring: add up all checked boxes on PHQ-9
For every 3 Not at all = 0; Several days = 1;
More than half the days = 2; Nearly every day = 3

• See Table below:
Total Score Depression Severity
0-4 No or Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression
Should be Empty: