Skip to content
Askalot

← All Healthcare templates

Questionnaire template

Patient Health Questionnaire (PHQ-9)

Screens adults for depressive symptoms over the last two weeks with the free PHQ-9 and its functional-difficulty item.

Preview

Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

How You Have Been Feeling

  1. Thank you for completing this short questionnaire about your mood. Your answers are confidential and help your care team understand how you have been.

  2. This questionnaire is the Patient Health Questionnaire-9 (PHQ-9), developed by Drs. Robert L. Spitzer, Janet B. W. Williams, Kurt Kroenke and colleagues. No permission is required to use it.

  3. Your score is a screening aid, not a diagnosis. A health professional should review it with you.

  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
    • Trouble falling or staying asleep, or sleeping too 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 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

  5. You said you have had thoughts of being better off dead or of hurting yourself. Please talk to a doctor, a mental health professional or a crisis line today. If you are in immediate danger, call your local emergency number.

Daily Life

  1. 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?

    Condition: Shown when at least one item is above Not at all (sum of keys above 9)

    Choose one:

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

Next Steps

  1. Are you currently receiving treatment or support for low mood or depression?

    Choose one:

    • Yes
    • No
    • Prefer not to say

  2. Would you like a health professional to contact you to discuss your answers?

    Choose one:

    • Yes
    • No