PHQ-9 Adolescent (PHQ-A)

First Name

Last Name

How often have you been bothered by each of the following symptoms during the past two weeks?

Feeling down, depressed, irritable, or hopeless?

Not at all Several days More than half the days Nearly every day

Little interest or pleasure in doing things?

Not at all Several days More than half the days Nearly every day

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

Not at all Several days More than half the days Nearly every day

Poor appetite, weight loss, or overeating?

Not at all Several days More than half the days Nearly every day

Feeling tired, or having little energy?

Not at all Several days More than half the days Nearly every day

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

Not at all Several days More than half the days Nearly every day

Trouble concentrating on things like school work, reading, or watching TV?

Not at all Several days More than half the days Nearly every day

Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you were moving around a lot more than usual?

Not at all Several days More than half the days Nearly every day

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

Not at all Several days More than half the days Nearly every day

In the past year, have you felt depressed or sad most days, even if you felt okay sometimes?

Yes No

If you are experiencing any of the problems on this form, 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

Has there been a time in the past month when you have had serious thoughts about ending your life?

Yes No

Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt?

Yes No

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