Depression Questionnaire – www.carrouseltherapycenter.com

Patient Depression Questionnaire (PHQ-9)

Patient ID:

Date

Patient Name

First

Last

Over the last 2 weeks, how often have you been bothered by any of the following problems?

0-4 Minimal or non Monitor; may not require treatment 5-9 Mild 10-14 Moderate (Use clinical judgment {symptom duration, functional impairment} to determine necessity of treatment) 15-19 Moderate severe 20-27 Severe (Warrants active treatment with psychotherapy, medications, or combination)

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling or staying asleep, or sleeping to 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 your family down

7. Trouble concentrating or things, such as reading the newspaper or watching television

8. Moving or speaking so slowly that other people could notice, or the opposite (moving a lot more that normal)

9. Thoughts that you would be better off dead, or of hurting yourself

Ranking

0-4 Minimal or Non-Monitor

5-9 Mild

10-14 Moderate

15-19 Moderate Severe

20-27 Severe

CRITICAL ACTIONS: Perform suicide risk assessment in patients who respond positively to item 9 “Thoughts that you would be better off dead or of hurting yourself in some way.” Rule out bipolar disorder, normal bereavement, and medical disorders causing depression.

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