Depression Assessment (PHQ-9)
Name *
Your answer
Today's Date *
MM
/
DD
/
YYYY
Email Address *
Your answer
Over the last 2 weeks how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things *
Feeling down, depressed or hopeless *
Trouble falling/staying asleep, sleeping to much *
Feeling tired or having little energy *
Poor appetite or overeating *
Feeling bad about yourself - or that you are a failure or have let yourself or your family down *
Trouble concentrating on things, such as reading the newspaper or watching television *
Moving or speaking so slowly that other people could have noticed. Or the opposite being so fidgety/restless that you have been moving around a lot more than usual *
Thoughts that you would be better off dead, or of hurting yourself in some way *
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? *
Patient Health Questionnaire (PHQ) Copyright© 1999 Pfizer Inc. All rights reserved.
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