Patient Health Questionnaire (PHQ-9) Printed Patient's Legal Name(Required) First Last Date MM slash DD slash YYYY 1) Over the last 2 weeks, how often have you been bothered by any of the following problems?A) Little interest or pleasure in doing things Not at all Several days More than half the days Nearly every day B) Feeling down, depressed, or hopeless Not at all Several days More than half the days Nearly every day C) Trouble falling/staying asleep, sleeping too much Not at all Several days More than half the days Nearly every day D) Feeling tired or having little energy Not at all Several days More than half the days Nearly every day E) Poor appetite or overeating Not at all Several days More than half the days Nearly every day F) Feeling bad about yourself or that you are a failure or have let yourself or your family down Not at all Several days More than half the days Nearly every day G) Trouble concentrating on things, such as reading the newspaper or watching television. Not at all Several days More than half the days Nearly every day H) 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. Not at all Several days More than half the days Nearly every day I) Thoughts that you would be better off dead or of hurting yourself in some way Not at all Several days More than half the days Nearly every day 2) If you checked off any problem on this questionnaire sofar, 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?television. Not difficult at all Some what difficult Very Difficult Extremely difficult PHQ-9* Questionnaire for Depression Scoring and Interpretation Guide For physician use onlyScoring:Count the number (#) of boxes checked in a column. Multiply that number by the value indicated below, then add the subtotal to produce a total score. The possible range is 0-27. Use the table below to interpret the PHQ-9 score.