Depression Questionnaire - Calder Community Practice

This easy to use patient questionnaire has been validated for use in Primary Care.

It is used by your doctor to monitor the severity of depression and response to treatment.

It can also be used to make a tentative diagnosis of depression.

PHQ-9 Depression Assessment Questionnaire

Your Contact Details

Title

Name

First Last

Date of Birth

Contact Number

Address

Street Address Address Line 2 City County / State / Region Post Code

Questionnaire

Over the last two 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 or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself, or that you are a failure or have let yourself or your family down

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

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

Thoughts that you would be better off dead, or of hurting yourself in some way

Finally

If you checked off any problems, 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?