|
PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
|
|
|
Over the past 2 weeks, how often have you been bothered by any of the following problems?
|
|
|
Little interest or pleasure in doing things
|
|
|
Feeling down, depressed, or hopeless
|
|
|
Trouble falling asleep, staying asleep, or sleeping too much
|
|
|
Feeling tired or having little energy
|
|
|
Poor appetite or overeating
|
|
|
Feeling bad about yourself -- or that you're a failure or have let yourself or your family down
|
|
|
Trouble concentrating on things, such as reading the newspaper or watching TV
|
|
|
Moving or speaking slowly that other people could have noticed. Or the opposite, being so fidgety or restless?
|
|
|
Thoughts you would be better off dead or of hurting yourself in some way
|
|
|
How difficult have those problems made it for you to do your work, take care of things at home, or get along with other people?
|
|
|
GENERALIZED ANXIETY DISORDER QUESTIONNAIRE (GAD-7)
|
|
|
Over the past 2 weeks, how often have you been bothered by any of the following problems?
|
|
|
Feeling anxious, nervous, or on edge
|
|
|
Not being able to stop or control worrying
|
|
|
Worrying too much about different things
|
|
|
Trouble relaxing
|
|
|
Being so restless it is hard to sit still
|
|
|
Becoming easily annoyed or irritable
|
|
|
Feeling afraid as if something awful is going to happen
|
|
|
How difficult have those problems made it for you to do your work, take care of things at home, or get along with other people?
|
|
|
BRIEF SAFETY SCREEN
|
|
|
In the past few weeks, have you wished you were dead or wish that you could go to sleep and not wake up?
|
|
|
In the past few weeks, have you felt that either you or your family would be better off if you were dead?
|
|
|
In the past few weeks, have you been having thoughts about killing yourself?
|
|
|
In the past few weeks, have you experienced any of the following feelings? (Please check all that apply)
• • •
|
|
|
NATIONAL SUICIDE PREVENTION LIFELINE: 1-800-273-8255
|
|
