Patient Health Questionnaire (PHQ-9)Patient Health Questionnaire (PHQ-9)Michael Frampton M.D., P.C.9120 Connecticut Drive, Suite AMerrillville, IN 46410First NameMiddle InitialLast NameSuffix (Sr, Jr, etc.)Today's Date:Over the last two weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing things? 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day2. Feeling down, depressed, or hopeless? 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day3. Trouble falling or staying asleep, or sleeping too much? 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day4. Feeling tired or having little energy? 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day5. Poor appetite or overeating? 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down? 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day7. Trouble concentrating on things, such as reading the newspaper or watching television 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day8. 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 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every Day9. Thoughts that you would better off dead, or hurting yourself 0 - Not at all 1 - Several Days 2- More than half the days 3 - Nearly Every DayTotal Score:If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficultInterpretation of Total ScoreThis is calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively, of “not at all,” “several days,” “more than half the days,” and “nearly every day.”Total score for the nine items ranges from 1 to 27.1–4: Minimal depression5–9: Mild depression10–14: Moderate depression15-19: Moderately severe depression20-27: Severe depressionPHQ9 Copyright © Pfizer Inc. All rights reserved. PRIME-MD ® is a trademark of Pfizer Inc.Email Address: Retype Email Address:Submit Form
