PATIENT HEALTH QUESTIONNAIRE (PHQ-9) NAME:, DATE: Over the last 2 weeks, how often have you been bothered by any of the following problems? a (use °/* to indicate your answer) ot at an | Several | Mote han Nearty evel days | ae ry day 4. Litla interest or pleasure in doing things . 1 2 3 2. Fealing down, depressad, or hopalass ° ' 2 3 0 1 2 3 3. Trouble falling or staying asieep, or sleeping too much ‘4. Fooling tired or having litle energy ° 1 2 3 6. Poor apatite or overeating ® is 2 a 8. Feeling bad about yourselt—or that you ara a fallure or é i 3 4 have let yourself or your family down 7. Trouble concentrating on things, such as reading the ° : 2 3 newspaper or watching telovision 8. Moving or speaking £0 slowiy that other people could have nolicad. Orthe opposite _ being so figely o- i A 3 3 rastiess that you have bean moving around # lot mam than usual 8. Thoughts that you would be better off dead, or of ° ' > 3 hurting yourself add columns (Heatthcare professional: For interpretation of TOTAL, TOTAL: ploase refer to accompanying sooring card). 40. If you chacked off any problems, how oificutt Not difficut at all have thase problems made it for you to do Somewhat difcut Your Work, take care of things at home, or get ‘ry ditt along with other paopla? Extremely cttficutt Copyright © 1999 Pfizer Inc, All rights reserved, Reproduced with permission, PRIME-MDG is a trademark of Pfizer Inc, A2663B 10-04-2005