Mental Health Assessment Form✅
- Veronica Muthee
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 | 167006 Little interest or pleasure in doing things over past two weeks |
Feeling down, depressed or hopeless 🔘 Not at all 🔘 Several days 🔘 More than half the days 🔘 Nearly every day | 167007 Feeling down, depressed, or hopeless over past two weeks |
PHQ-9 |
|
Trouble falling asleep, staying asleep, or sleeping too much 🔘 Not at all 🔘 Several days 🔘 More than half the days 🔘 Nearly every day | 167068 Trouble falling or staying asleep, or sleeping too much over past two weeks |
Feeling tired or having little energy 🔘 Not at all 🔘 Several days 🔘 More than half the days 🔘 Nearly every day | 167069 Feeling tired or having little energy over past two weeks
|
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 | 167071 Feeling bad about yourself or that you're a failure or have let yourself or your family down |
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 | 167072 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 🔘 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 | 167074 Thoughts that you would be better off dead or of hurting yourself in some way |
PHQ-9 score obtained by adding score for each question ___________________________ | |
Notes |