PHQ-9 / GAD-7    

Patient name:
Date:

A. Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
Q1. Little interest or pleasure in doing things
Q2. Feeling nervous, anxious or on edge
Q3. Feeling down, depressed, or hopeless
Q4. Not being able to stop or control worrying
Q5. Trouble falling or staying asleep, or sleeping too much
Q6. Worrying too much about different things
Q7. Feeling tired or having little energy
Q8. Trouble relaxing
Q9. Poor appetite or overeating
Q10. Being so restless that it is hard to sit still
Q11. Feeling bad about yourself or that you are a failure or have let yourself or your family down
Q12. Becoming easily annoyed or irritable
Q13. Trouble concentrating on things, such as reading the newspaper or watching television
Q14. Feeling afraid as if something awful might happen
Q15. 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
Q16. Thoughts that you would be better off dead, or of hurting yourself in some way

B. If you checked off any problems, 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

PHQ-9 GAD-7
*Immediate discussion required. Refer to emergency resource for further assessment and intervention as appropriate.
Assess degree of suicide risk and possible harm to self and others.		 Immediate discussion required.  Refer to emergency resource as appropriate.
Assess degree of suicide risk and possible harm to self and others.		 Consider Safety Plan:
*GAD-7 score is 10 or higher. Consider further anxiety evaluation.

Instructions - How to Score the PHQ-9   (Questions Q1, Q3, Q5, Q7, Q9, Q11, Q13, Q15, Q16)

Major depressive disorder is suggested if:

  • either Q1 or Q2 is positive, that is at least "more than half the days"
  • of the 9 items, 5 or more are checked as at least "more than half the days"

Other depressive syndrome is suggested if:

  • either item Q1 or Q2 is positive, that is at least "more than half the days"
  • of the 9 items, 2 to 4 are checked as at least "more than half the days"

Also, PHQ-9 scores can be used to plan and monitor treatment.     Interpret the score by using the guide below.


PHQ-9 Score     Provisional Dx   Rx Recommendations
  Dx Reference     Rx Reference
0 - 4 Remission or no depression   Rx may not be needed
5 - 9 Minimal symptoms   Support, educate to call if worse, return in 1 month
10 - 14 See Dx reference, consider DDx   See Rx reference, consider DDx
15 - 19 Major depression, moderately severe   Antidepressant OR psychotherapy
≥ 20 Major depression, severe   Antidepressant AND psychotherapy (especially if not improved on monotherapy); follow frequently

GAD-7 Score     Provisional Dx   GAD7 Reference
0 - 4 No anxiety
5 - 9 Mild anxiety
10 - 14 Moderate anxiety
15 - 21 Severe anxiety

Subject:
Creative Commons License
PHQ9_GAD7 combined eFORM, V14_May28_2022 is licensed under a GPL.
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