Self assessment questionnaires

Patient Health Questionnaire (PHQ-9)

Over the last two weeks, how often have you been bothered by any of the following problems?

a) Little interest or pleasure in doing things?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

b) Feeling down, depressed, or hopeless?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

c) Trouble falling or staying asleep, or sleeping too much?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

d) Feeling tired or having little energy?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

e) Poor appetite or overeating?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

f) Feeling bad about yourself – or that you are a failure or have let yourself or your family down?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

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

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

h) 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?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

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

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

Total – ___/27

Depression Severity: 0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.

GENERALIZED ANXIETY DISORDER QUESTIONAIRE – SELF REPORT VERSION

SYMPTOMS/SIGNS NOT AT ALL SOMEWHAT DIFFICULT VERY DIFFICULT EXTREMELY DIFFICULT
  1. EXCESSIVE ANXIETY OR WORRY ABOUT A NUMBER OF EVENTS AND ACTIVITIES?
0 1 2 3
2. FINDING IT DIFFICULT TO CONTROL WORRYING? 0 1 2 3
3. FEELING RESTESS, KEYED UP OR ON EDGE? 0 1 2 3

 

4. BEING EASILY FATIGUED?

 

0 1 2 3
5.DIFFICULTY CONCENTRATING OR MIND GOING BLANK? 0 1 2 3
6. BEING IRRITABLE?

 

0 1 2 3
7. FEELING MUSCLE TENSION?

 

0 1 2 3
8. HAVING DISTURBED SLEEP LIKE DIFFICULTY FALLING ASLEEP, STAYING ASLEEP OR HAVING RESTLESS, UNREFRESHING SLEEP? 0 1 2 3
9. FEELING DISTRESSED BECAUSE OF THESE PROBLEMS? 0 1 2 3
10. HOW DIFFICULT THESE PROBLEMS MADE IT FOR YOU TO DO YOUR WORK, TAKE CARE OF THINGS AT HOME OR GET ALONG WITH OTHER PEOPLE? 0 1 2 3
TOTAL SCORE

 

 Scoring: Clinical anxiety    ≥ 10(mild)      ≥15(moderate),     ≥ 20 (severe)