PHQ-9 Depression Assessment Questionnaire

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Contact Details
Name:		Date of Birth:
Address		Postcode
		Home Phone

Questionnaire
Over the last two weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things		Please choose an option Not at all Several days More than half the days Nearly every day
Feeling down, depressed, or hopeless		Please choose an option Not at all Several days More than half the days Nearly every day
Trouble falling or staying asleep, or sleeping too much		Please choose an option Not at all Several days More than half the days Nearly every day
Feeling tired or having little energy		Please choose an option Not at all Several days More than half the days Nearly every day
Poor appetite or overeating		Please choose an option Not at all Several days More than half the days Nearly every day
Feeling bad about yourself, or that you are a failure or have let yourself or your family down		Please choose an option 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		Please choose an option 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		Please choose an option 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		Please choose an option Not at all Several days More than half the days Nearly every day
Finally

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?		Please choose an option Not at all Several days More than half the days Nearly every day