Name
*
First Name
Last Name
Email
*
Please summarize what you learned after completing this worksheet.
1. Little interest or pleasure in doing things
0
1
2
3
2. Feeling down, depressed or hopeless
0
1
2
3
3. Trouble falling asleep, staying asleep, or sleeping too much
0
1
2
3
4. Feeling tired or having little energy
0
1
2
3
5. Poor appetite or overeating
0
1
2
3
6. Feeling bad about yourself - or that you're a failure or have let yourself or your family down.
0
1
2
3
7. Trouble concentrating on things, such as reading the newspaper or watching television
0
1
2
3
8. 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.
0
1
2
3
9. Thoughts that you would be better off dead or of hurting yourself in some way.
0
1
2
3
Step 2: The PHQ-9 is scored on a scale of 0-27. Add up the “1”, “2”, and “3” columns and then total them to get the score. Scores represent: 0-5 = mild; 6-10 = moderate; 11-15 = moderately severe depression; 16+ = severe depression.
Step 3: If you circled any problems “1”, “2” or “3” how difficult have these made it for you one to work, take care of things at home, or get along with other people? (Choose one.)
Not difficult at all
Somewhat difficult
Very difficult
Extremely Difficult
