PHQ- 9A: Modified for Adolescents

Ages 11-17: PHQ- 9A Modified for Adolescents

2023
Client 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?*

Phoenix 104Phoenix 108Phoenix 205CottonwoodTucsonLaveenTelemedicine/TeleHealthIn SchoolIn Home
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. Feeling down, depressed, irritable, or hopeless?

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
2. Little interest or pleasure in doing things?

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. Poor appetite, weight loss, or overeating?

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

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

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every DayOther
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 ofhurting yourself in some way?

0 Not At All1 Several Days2 More Than Half The Days3 Nearly Every Day
Total Score Depression Severity
• 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
In the past year have you felt depressed or sad most days, even if you felt okay sometimes?

YesNo
If you are experiencing any of the problems on this form, how difficult have these problems made if 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
Has there been a time in the past month when you have had serious thoughts about ending your life?

YesNo
Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt?

YesNo
**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.

Scoring the PHQ-9 modified for Teens
Scoring the PHQ-9 modified for teens is easy but involves thinking about
several different aspects of depression.

To use the PHQ-9 as a diagnostic aid for Major Depressive Disorder:
• Questions 1 and/or 2 need to be endorsed as a “2” or “3”
• Need five or more positive symptoms (positive is defined by a “2” or
“3” in questions 1-8 and by a “1”, “2”, or “3” in question 9).

• The functional impairment question (How difficult....) needs to be
rated at least as “somewhat difficult.”
To use the PHQ-9 to screen for all types of depression or other mental
illness:
• All positive answers (positive is defined by a “2” or “3” in questions 1-8
and by a “1”, “2”, or “3” in question 9) should be followed up by
interview.
• A total PHQ-9 score > 10 (see below for instructions on how to obtain
a total score) has a good sensitivity and specificity for MDD.
To use the PHQ-9 to aid in the diagnosis of dysthymia:
• The dysthymia question (In the past year...) should be endorsed as
“yes.”
To use the PHQ-9 to screen for suicide risk:
• All positive answers to question 9 as well as the two additional suicide
items MUST be followed up by a clinical interview.
To use the PHQ-9 to obtain a total score and assess depressive severity:
• Add up the numbers endorsed for questions 1-9 and obtain a total
score.

• 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:

Ages 11-17: PHQ- 9A Modified for Adolescents