Adolescent Depression Screening

Please correct the errors described below.

Patient Name

Date of Birth

Date

Over the past two weeks have you:

Been feeling down, depressed or hopeless?

Yes No

Had little interest or pleasure in doing things? For example: have you had less interest in doing things you typically enjoy?

Yes No

If you answered “yes” to either of these questions, please complete the following questionnaire. Thank you.

Patient Health Questionnaire (PHQ-9)

Over the last 2 weeks have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things

Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)

2. Feeling down, depressed or hopeless

Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)

3. Trouble falling or staying asleep, or sleeping too much

Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)

4. Feeling tired or having little energy

Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)

5. Poor appetite or overeating

Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)

6. 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 the days (2) Nearly every day (3)

7. Trouble concentrating on things, such as reading the newspaper or watching television

Not at all (0) Several days (1) More than half the days (2) Nearly every day (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

Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)

9. 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 the days (2) Nearly every day (3)

Add for total score:

NOTE: 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 is adapted from PRIME MD TODAY, developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues with an educational grant from Pfizer Inc. For research information, contact Dr. Spitzer at rls@columbia.edu.

Scoring the PHQ-9 for items 1-9:

PHQ-9 score 0-4 (Not clinically depressed)
PHQ-9 score 5-9 (Mild depression)
PHQ-9 score 10-14 (Moderate depression)
PHQ-9 score 15 – 19 (Moderately severe depression)
PHQ-9 score 20-27 (Severe depression)

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