PHQ-9 Form

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PHQ-9 Form

Questionnaire for Depression Scoring - This tool will help assess the presence and severity of depression

Email *

Your Full Name *

Your Contact Number *

1. Little interest or pleasure in doing things *

2. Feeling down, depressed, or hopeless *

3. Trouble falling or 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 or 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 have been moving around a lot more than usual *

9. Thoughts that you would be better off dead or of hurting yourself in some way *

If you checked off any problem on this questionnaire so far, 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 all

Somewhat difficult

Very difficult

Extremely difficult

Referred From *

A copy of your responses will be emailed to the address you provided.

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This form was created inside of Trust Mental Health.