Depression Screen PHQ-9 Date MM slash DD slash YYYY Name First Last Over the past 2 weeks, how often have you been bothered by any of the following problems? 1) Little interest of pleasure in doing things. Not at all Several Days More than half the days Nearly every day 2) Feeling down, depressed, or hopeless Not at all Several Days More than half the days Nearly every day 3) Trouble falling or staying asleep, or sleeping too much Not at all Several Days More than half the days Nearly every day 4) Feeling tired or having little energy Not at all Several Days More than half the days Nearly every day 5) Poor appetite or overeating Not at all Several Days More than half the days Nearly every day 6) Feeling bad about yourself - or that you are a failure or have let yourself or your family down Not at all Several Days More than half the days Nearly every day 7) Trouble concentrating on things, such as reading, watching TV Not at all Several Days More than half the days Nearly every day 8) Moving or speaking s 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 Not at all Several Days More than half the days Nearly every day 9) Thoughts that you would be better off dead or of hurting yourself in some way Not at all Several Days More than half the days Nearly every day If you checked any problems on this questionnaire so far, mark how DIFFICULT these problems have made it for you to do your work, take care of things at home, or get long with peopleNot difficult at allSomewhat difficultVery difficultExtremely difficultCAPTCHA