PATIENT HEALTH QUESTIONNAIRE-9 (PHQ-9) Over the last 2 weeks, how often have you been bothered Mors Nearly by any of te ing problems? ‘Several then half every (Use “oto indicate your answer) Novotel days thedays day 1. Lite interest or pleasure in doing things o 1 2 3 2. Fesling down, depressed, or hopeless ° 1 etesitia: 2. Trouble fling or staying asleep, or sleeping foo much ° 1 2 3 4, Feeling tired or naving litle energy ° 1 oie: ‘5 Poor appetite or overeating ° 4 2 3 6. Feeling bed about yourself — or thal you era a fllure oF ° i 7 3 have let yourself or your family dovm 1. Trouble concentrating on things, such as reading the ° 4 7 3 ‘newepaper oF watching television 8. Moving or epeaking 60 slowly thal other peopla could have noticed? Or the opposite — being so fidgety or restless ° i 2 3 that you have been moving eround a lot more than usual 8. Thoughis that you would be better off dead or of hurting Fs 7 a 3 ‘yoursefin some wey Fororrice coowe_O__ + F ssiiats paises Total Soon: 1 Ifyou checked off any problems, how glificulf have these prablems made lt for you to do your ‘work, take care of things at home, or get along with other people Not difficutt Somewhat Very. Extremely ‘at all moult arent dificult ped by Drs, Robert L. Splizr, Janet B.W. Wilams, Kurt Kroenke and colleagues, with an educaional gant from Pfizer Inc. No permission required to reproduce, translate, splay or distibute,ae Over the lasi 2 weeks, how often have you Not Severat MOre tn early been bothered by the following problems? stall cays aye’ every day (Use “v* to indicate your answer) 1. Feeling nervous, anxious or on edge ° i 2 3 2. Not being able to stop or control worying ° 1 2 3 3. Worrying to0 much about different things ° 1 2 3 4, Trouble relaxing 0 1 2 3 §. Being so restiess that itis hard to sit stil ° 1 2 3 8. Becoming easily annoyed or initable o 4 2 3 7. Feeling afraid as if something evful ° 1 2 3 might happen {For offixe coding: Total Scare T___ = + pier): Please give this form to your provider and give the clipboard to the front desk. Thank you! Developed by Drs. Rober L. Spitzer, Janet B.W. Willams, Xurt Kroenke end coleagues, with an ‘educational grant from Pfizer Ino. No permission required to reproduce, tenslate, display or dstibute,