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Questions

Concepts

PHQ-2

Screening Date

␣␣-␣␣-␣␣␣␣ 📆

Little interest or pleasure in doing things

🔘 Not at all

🔘 Several days

🔘 More than half the days

🔘 Nearly every day

Feeling down, depressed or hopeless

🔘 Not at all

🔘 Several days

🔘 More than half the days

🔘 Nearly every day

PHQ-9

Trouble falling asleep, staying asleep, or sleeping too much

🔘 Not at all

🔘 Several days

🔘 More than half the days

Feeling tired or having little energy

🔘 Not at all

🔘 Several days

🔘 More than half the days

🔘 Nearly every day

Poor appetite or overeating

🔘 Not at all

🔘 Several days

🔘 More than half the days

🔘 Nearly every day

Feeling bad about yourself - or that you’re a failure or have let yourself or your family down

🔘 Not at all

🔘 Several days

🔘 More than half 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 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 the days

🔘 Nearly every day

Thoughts that you would be better off dead or of hurting yourself in some way

🔘 Not at all

🔘 Several days

🔘 More than half the days

🔘 Nearly every day

PHQ-9 score obtained by adding score for each question

___________________________

Notes

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