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Patient Health Questionnaire (PHQ-9)
Name
First
Last
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Little interest of pleasure in doing things
Not at all
Several days
More than half of the days
Nearly every day
Feeling down, depressed, or hopeless
Not at all
Several days
More than half of the days
Nearly every day
Trouble falling/staying asleep, sleeping too much
Not at all
Several days
More than half of the days
Nearly every day
Feeling tired or having little energy
Not at all
Several days
More than half of the days
Nearly every day
Poor appetite or overeating
Not at all
Several days
More than half of the days
Nearly every day
Feeling bad about yourself or that you are a failure or have let yourself of your family down
Not at all
Several days
More than half of the days
Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television
Not at all
Several days
More than half of the days
Nearly every day
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 of the days
Nearly every day
Thoughts that you would be far better off dead or of hurting yourself in some way
Not at all
Several days
More than half of the days
Nearly every day
If you checked off any problems 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 at all
Several days
More than half of the days
Nearly every day
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