• PHQ-9 Questionnaire

    PHQ-9 Questionnaire

    2023
  • Date of Birth*
     - -
  • Phase of Treatment*
  • Today's Date*
     - -
  • In what setting do you receive services?*

  • 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?*
  • 2. Feeling down, depressed, irritable, or hopeless?*
  • 3. Trouble falling asleep, staying asleep, or sleeping too much?*
  • 4. Feeling tired, or having little energy?*
  • 5. Poor appetite, weight loss, or overeating?*
  • 6. Feeling bad about yourself – or feeling that you are a failure, or that you have let yourself or your family down?*
  • 7. Trouble concentrating on things like school work, reading, or watching TV?*
  • 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?*
  • 9. Thoughts that you would be better off dead, or of hurting yourself in some way?*
  • 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?*

  • 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: