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Patient Health Questionnaire

The Patient Health Questionnaire (PHQ) is a self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Unlike the PRIME-MD (which measured 18 mental disorders), the PHQ measures five of the most common mental disorders in the general population as defined by the DSM-IV: major depression, anxiety, somatoform disorders, alcohol abuse, and eating disorders. Test-takers diagnosed as having a disorder according to the PHQ generally have more functional impairment, disability days, and use of the health care system than do test-takers without any diagnosis. For this questionnaire, please indicate the degree to which you have experienced the given symptoms during the last 2 weeks. Please answer all applicable questions to the best of your ability. The test takes about 5 minutes to complete.
Sources
Spitzer, R. L., Williams, J. B. W., & Kroenke, K. (1999). Patient health questionnaire doi:http://dx.doi.org/10.1037/t02598-000
You are a male | female

1. During the last 4 weeks, how much have you been bothered by any of the following problems? Not Bothered Bothered a Little Bothered a Lot
a. Stomach pain
b. Back pain
c. Pain in your arms, legs, or joints (knees, hips, etc.)
d. Menstrual cramps or other problems with your periods
e. Pain or problems during sexual intercourse
f. Headaches
g. Chest pain
h. Dizziness
i. Fainting Spells
j. Feeling your heart pound or race
k. Shortness of breath
l. Constipation, loose bowels, or diarrhea
m. Nausea, gas, or indigestion

2. Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several Days More than half the days Nearly every day
a. Little interest or pleasure in doing things
b. Feeling down, depressed, or hopeless
c. Trouble falling or staying asleep, or sleeping too much
d. Feeling tired or having little energy
e. Poor appetite or overeating
f. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
g. Trouble concentrating on things, such as reading the newspaper or watching television
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
i. Thoughts that you would be better off dead or of hurting yourself in some way

3. Questions about anxiety. No Yes
a. In the last 4 weeks, have you had an anxiety attack –– suddenly feeling fear or panic?
If you checked “NO”, go to question #5.
b. Has this ever happened before?
c. Do some of these attacks come suddenly out of the blue –– that is, in situations where you don’t expect to be nervous or uncomfortable?
d. Do these attacks bother you a lot or are you worried about having another attack?

4. Think about your last bad anxiety attack. No Yes
a. Were you short of breath?
b. Did your heart race, pound, or skip?
c. Did you have chest pain or pressure?
d. Did you sweat?
e. Did you feel as if you were choking?
f. Did you have hot flashes or chills?
g. Did you have nausea or an upset stomach, or the feeling that you were going to have diarrhea?
h. Did you feel dizzy, unsteady, or faint?
i. Did you have tingling or numbness in parts of your body?
j. Did you tremble or shake?
k. Were you afraid you were dying?

5. Over the last 4 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days
a. Feeling nervous, anxious, on edge, or worrying a lot about different things.
If you checked “Not at all”, go to question #6.
b. Feeling restless so that it is hard to sit still.
c. Getting tired very easily.
d. Muscle tension, aches, or soreness.
e. Trouble falling asleep or staying asleep.
f. Trouble concentrating on things, such as reading a book or watching TV.
g. Becoming easily annoyed or irritable.

6. Questions about eating. No Yes
a. Do you often feel that you can’t control what or how much you eat?
b. Do you often eat, within any 2-hour period, what most people would regard as an unusually large amount of food?
If you checked “NO” to either #a or #b, go to question #9.
c. Has this been as often, on average, as twice a week for the last 3 months?

7. In the last 3 months have you often done any of the following in order to avoid gaining weight? No Yes
a. Made yourself vomit?
b. Took more than twice the recommended dose of laxatives?
c. Fasted –– not eaten anything at all for at least 24 hours?
d. Exercised for more than an hour specifically to avoid gaining weight after binge eating?

8. If you checked “YES” to any of these ways of avoiding gaining weight, were any as often, on average, as twice a week? No
Yes

9. Do you ever drink alcohol (including beer or wine)? No
Yes
If you clicked "NO" then go to question 11

10. Have any of the following happened to you more than once in the last 6 months? No Yes
a. You drank alcohol even though a doctor suggested that you stop drinking because of a problem with your health.
b. You drank alcohol, were high from alcohol, or hung over while you were working, going to school, or taking care of children or other responsibilities.
c. You missed or were late for work, school, or other activities because you were drinking or hung over.
d. You had a problem getting along with other people while you were drinking.
e. You drove a car after having several drinks or after drinking too much.

11. If you checked off any problems on this questionnaire, 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?

Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult




   

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