OLD-7. Patient Health Questionnaire (PHQ9)-n

Patient Health Questionnaire (PHQ-9)

Identifies depression and recent/current mood state
Name*

First NameLast Name
Select your Therapist

Over the last two weeks, how often have you been bothered by the following problems?*

	Not sure at all (0) points each	Several days (1) point each	Over half the days (2) points each	Nearly every day (3) points each
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself - or that you are a failure or have let yourself or family down
7. Trouble concentrating on things such as reading the newspaper or watching television
8. 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
9. Thoughts that you would be better off dead or of hurting yourself in some way

PHQ-9, total score
If you checked off any problems in the above table, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?*

Not difficult at allSomewhat difficultVery difficultExtremely difficult
Should be Empty: