PHQ-9 - Nine Symptom Checklist: Patient Name Date

PHQ-9 — Nine Symptom Checklist
Patient Name Date
1. Over the last 2 weeks, how often have you been bothered by any of the following
problems? Read each item carefully, and circle your response.
a. Little interest or pleasure in doing things
Not at all Several days More than half the days Nearly every day
b. Feeling down, depressed, or hopeless

c. Trouble falling asleep, staying asleep, or sleeping too much

d. Feeling tired or having little energy

e. Poor appetite or overeating

f. Feeling bad about yourself, feeling that you are a failure, or feeling that you have
let yourself or your family down
g. Trouble concentrating on things such as reading the newspaper or watching

television
h. Moving or speaking so slowly that other people could have noticed. Or being so
fidgety or restless that you have been moving around a lot more than usual
i. Thinking that you would be better off dead or that you want to hurt yourself in
some way
2. If you checked off any problem on this questionnaire so far, 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?
Not Difficult at All Somewhat Difficult Very Difficult Extremely Difficult
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PHQ-9 — Scoring Tally Sheet
Patient Name Date
1. Over the last 2 weeks, how often have you been bothered by any of the
following problems? Read each item carefully, and circle your response.
Not Several More than Nearly

at all days half the days every day
0 1 2 3
a. Little interest or pleasure in doing things
b. Feeling down, depressed, or hopeless
c. Trouble falling asleep, staying asleep, or
sleeping too much
d. Feeling tired or having little energy
e. Poor appetite or overeating
f. Feeling bad about yourself, feeling that you are
a failure, or feeling that you have let yourself
or your family down
g. Trouble concentrating on things such as
reading the newspaper or watching television
h. Moving or speaking so slowly that other
people could have noticed. Or being so fidgety
or restless that you have been moving around a
lot more than usual
i. Thinking that you would be better off dead or
that you want to hurt yourself in some way
Totals
2. If you checked off any problem on this questionnaire so far, 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?
Not Difficult At All Somewhat Difficult Very Difficult Extremely Difficult

0 1 2 3
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How to Score PHQ-9
Scoring Method Major Depressive Syndrome is suggested if:

For Diagnosis • Of the 9 items, 5 or more are circled as at least "More than half the days"
• Either item 1a or 1b is positive, that is, at least "More than half
the days"
Minor Depressive Syndrome is suggested if:
• Of the 9 items, b, c, or d are circled as at least "More than half the
days"
• Either item 1a or 1b is positive, that is, at least "More than half
the days"
Scoring Method Question One

For Planning • To score the first question, tally each response by the number
And Monitoring
value of each response:
Treatment
Not at all = 0
Several days = 1
More than half the days = 2
Nearly every day = 3
• Add the numbers together to total the score.
• Interpret the score by using the guide listed below:
Score Action
<4 The score suggests the patient may not need depression
treatment.
> 5-14 Physician uses clinical judgment about treatment, based on

patient’s duration of symptoms and functional impairment.
>15 Warrants treatment for depression, using antidepressant,
psychotherapy and/or a combination of treatment
Question Two
In question two the patient responses can be one of four: not
difficult at all, somewhat difficult, very difficult, extremely difficult.
The last two responses suggest that the patient's functionality is
impaired. After treatment begins, the functional status is again
measured to see if the patient is improving.
3 Tools How to Score PHQ-9

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PHQ-9 — Nine Symptom Checklist

Patient Name Date

b. Feeling down, depressed, or hopeless

c. Trouble falling asleep, staying asleep, or sleeping too much

d. Feeling tired or having little energy

e. Poor appetite or overeating

g. Trouble concentrating on things such as reading the newspaper or watching

Copyright held by Pfizer Inc, but may be photocopied ad libitum

1 Tools May be printed without permission

Patient Name Date

Not Several More than Nearly

Not Difficult At All Somewhat Difficult Very Difficult Extremely Difficult

Copyright held by Pfizer Inc, but may be photocopied ad libitum

2 Tools May be printed without permission

Scoring Method Major Depressive Syndrome is suggested if:

Scoring Method Question One

> 5-14 Physician uses clinical judgment about treatment, based on

Copyright held by Pfizer Inc, but may be photocopied ad libitum

3 Tools How to Score PHQ-9

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