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Questionnaire template

Depression Severity Screening (PHQ-9)

Rates the severity of depressive symptoms in adults 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 over the past two weeks; your answers are confidential.

  2. This questionnaire is 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. Please discuss it with a health professional.

  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, Concentration and Movement

  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

    For each row: choose one:

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

Difficult Thoughts and Daily Life

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

    • 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 talk to a doctor or a local crisis line as soon as possible; if you are in immediate danger, call your 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