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PATIENT HEALTH QUESTIONNAIRE (PHQ)
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Over the last 2 weeks, how often have you been bothered by
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Depression
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1. Little interest or pleasure doing things
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2. Feeling down / depressed / hopeless
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3. Trouble falling or staying asleep, or sleeping too much
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4. Feeling tired and having little energy
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5. Poor appetite or over eating
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6. Feeling bad about yourself/feeling a failure/feeling you have let people down:
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7. Trouble concentrating on things, such as reading the newspaper/watching television
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8. Moving/Speaking so slow that other people could have noticed/the opposite
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9. Thoughts that you would be better off dead or of hurting yourself in someway
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Anxiety
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Over the last 2 weeks, how often have you been bothered by the following problems?
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1. Feeling nervous, anxious or on edge
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2. Not being able to stop or control worrying
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3. Worrying too much about different things
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4. Trouble relaxing
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5. Being so restless that it is hard to sit still
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6. Becoming easily annoyed or irritable
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7. Feeling afraid as if something awful might happen
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Attention and Focus
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Trauma
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In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:
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1. Have had nightmares about it or thought about it when you did not want to?
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2. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
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3. Were constantly on guard, watchful, or easily startled?
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4. Felt numb or detached from others, activities, or your surroundings?
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Insomnia
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Substance Abuse
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Other (please explain)
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