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Questionnaire template

Depression Screening (PHQ-9)

Screens adults for depressive symptoms over the past two weeks using the free PHQ-9 questionnaire.

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Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

Mood and Interest

  1. Thank you for taking part. The questions below ask how you have been feeling lately; your answers are confidential.

  2. This questionnaire uses the Patient Health Questionnaire-9 (PHQ-9), developed by Drs. Robert L. Spitzer, Janet B. W. Williams and Kurt Kroenke. It is free to use without permission.

  3. Your result is a screening aid, not a diagnosis. If you are having thoughts of harming yourself, please contact a health professional or a local crisis service right away.

  4. 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

    For each row: choose one:

    • Not at all
    • Several days
    • More than half the days
    • Nearly every day

Sleep, Energy and Appetite

  1. Over the last 2 weeks, how often have you been bothered by any of the following problems?

    • Trouble falling or staying asleep, or sleeping too much
    • Feeling tired or having little energy
    • Poor appetite or overeating

    For each row: choose one:

    • Not at all
    • Several days
    • More than half the days
    • Nearly every day

Self-View, Focus and Activity

  1. Over the last 2 weeks, how often have you been bothered by any of the following problems?

    • 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 or 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

    For each row: choose one:

    • Not at all
    • Several days
    • More than half the days
    • Nearly every day

  2. You indicated thoughts of being better off dead or of hurting yourself. Please reach out today to a doctor, a mental health professional or a local crisis line; if you are in immediate danger, call your local emergency number.

  3. 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?

    Choose one:

    • Not difficult at all
    • Somewhat difficult
    • Very difficult
    • Extremely difficult