PATIENT HEALTH QUESTIONNAIRE

PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
Name

First NameLast Name
BIRTHDATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
PHQ-9 is adapted from PRIME MD TODAY, developed by Drs Robert L. Spitzer, Jane B.W. Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer Inc. For research information, contact Dr Spitzer at rls8@columbia.edu. Use of the PHQ-9 may only be made in accordance with the Terms of Use available at http://www.pfizer.com. Copyright C 1999 Pfizer Inc. All rights reserved. PRIME MD TODAY is a trademark of Pfizer Inc.

Over the last two weeks, how often have you been bothered by the following problems? (check to indicate answer)

Rows	Not at all (0)	Several Days (1)	More than half the days (2)	Nearly every day (3)
1. Little interest or pleasure in doing things
2. Feeling down depressed or hopeless
3. Trouble falling /staying asleep or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself- or that you are a failure or have let yourself of your family down
7. Trouble concentrating on things such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed. Or the opposite- being so fidgety or restless that you've been moving around a lot more than usual
9. Thoughts that you'd 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, or get along with other people?
Should be Empty:

PATIENT HEALTH QUESTIONNAIRE (PHQ-9)