Patient Health Questionnaire for Depression (PHQ-9)

If you have been advised by the surgery to submit a Patient Health Questionnaire (PHQ-9) please use this form.

The Patient Health Questionnaire for Depression (PHQ-9) is a nine-question instrument given to patients in a primary care setting to screen for the presence and severity of depression.

Your score in the second section of the questionnaire does not affect that of the first section.

Patient Health Questionnaire for Depression (PHQ-9)

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.


Over the last 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 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: *

All three questions below are marked on a scale of 0-8 depending on how much you avoid the circumstances described, shown below. You can choose a number from the summarised scale below, then recording the number.

0 = Would not avoid it, 2 = Slightly avoid it, 4 = Definitely avoid it, 6 = Markedly avoid it, 8 = Always avoid it.

Your score in this section does not affect that of the first section of the questionnaire.

Social situations due to a fear of being embarrassed or making a fool of myself *
Certain situations because of a fear of having a panic attack or other distressing symptoms (such as loss of bladder control, vomiting or dizziness) *
Certain situations because of a fear of particular objects or activities (such as animals, heights, seeing blood, being in confined spaces, driving or flying) *
I give my consent for SMS text messaging *