Anxiety

BRIEF PATIENT HEALTH QESTIONAIRE (Brief PHQ)

Drs. Robert L. Spitzer‚ Janet B.W. Williams‚ Kurt Kroenke

BRIEF PATIENT HEALTH QESTIONAIRE (Brief PHQ)
This questionnaire is an important part of providing you with the best health care possible. Your answers will help in understanding problems that you may have. Please answer every to the best of your ability unless you are requested to skip a .
Name                    Age                           Sex: □ Female □ Male           Today’s Date
 
1
Over the last 2 weeks‚ how often have you been bothered by any of the following problems?
 
a.     Little interest or pleasure in doing things
Not
at all
Several
 days
More than
half the days
Nearly
 every day
 
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
 
 
 
 
 
.
 
2. 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 3.
 
 
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?
 
 
e.    During your last bad anxiety attack‚ did you have symptoms like shortness of breath‚ sweating‚ your heart racing or pounding‚ dizziness or faintness‚ tingling or numbness‚ or nausea or upset stomach?
 
 
 
 
3. If you checked off any problems on this questionnaire so far‚ 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
 
4. In 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. Worrying about your health
 
 
 
b. Your weight or how you look
 
 
 
c. Little or no sexual desire or pleasure during sex
 
 
 
d. Difficulties with husband/wife‚ partner/lover‚ or boyfriend/girlfriend
 
 
 
e. The stress of taking care of children‚ parents‚ or other family members
 
 
 
f. Stress at work outside of the home or at school
 
 
 
g. Financial problems or worries
 
 
 
h. ha‎ving no one to turn to when you have a problem
 
 
 
i. Something bad that happened recently
 
 
 
j. Thinking or dreaming about something terrible that happened to you in the past—like your house being destroyed‚ a severe accident‚ being hit or assaulted‚ or being forced to commit a sexual act
 
 
 
 
5. In the last year‚ have you been hit‚ slapped‚ kicked‚ or otherwise physically hurt by someone‚ or has anyone forced you to have an unwanted sexual act?
NO
YES
 
 
6. What is the most stressful thing in your life right now? -‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-‎-
 
 
7. Are you taking any medication for anxiety‚ depression‚ or stress?
NO
YES
 
8. FOR WOMEN ONLY:  Questions about menstruation‚ pregnancy‚ and childbirth.
a. Which best describes your menstrual periods?
 
Periods are unchanged
 
No periods because pregnant or recently gave birth
 
Periods have become irregular or changed in frequency‚ duration‚ or amount
 
No periods for at least a year
 
ha‎ving periods because taking hormone replacement (estrogen) therapy or oral contraceptives
 
 
b. During the week before your period starts‚ do you have a serious problem with your mood—like depression‚ anxiety‚ irritability‚ anger‚ or mood swings?
NO
YES
NO
(or does not apply)
c. If YES‚ do these problems go away by the end of your period?
NO
YES
d. Have you given birth within the last 6 months?
NO
YES
e. Have you had a miscarriage within the last 6 months?
NO
YES
f. Are you ha‎ving difficulty getting pregnant?
NO
YES
 
Developed by Drs. Robert L. Spitzer‚ Janet B.W. Williams‚ Kurt Kroenke and colleagues‚ with an educational grant from Pfizer Inc. No permission required to reproduce‚ translate‚ display or distribute.
Developed by Drs Robert L. Spitzer‚ Janet B. W. Williams‚ Kurt Kroenke‚ and other colleagues‚ with an educational grant from Pfizer‚ Inc. For research information‚ contact
Dr. Spitzer at [email protected] The names PRIME-MD® and PRIME-MD TODAY® are trademarks of Pfizer Inc.
TX221I99G © 1999‚ Pfizer Inc
Personal Health Questionnaire Depression Scale (PHQ-9)
1
Over the last 2 weeks‚ how often have you been bothered by any of the following problems?
 
1.    Little interest or pleasure in doing things
Not
at all
Several
 days
More than
half the days
Nearly
 every day
 
2.    Feeling down‚ depressed‚ or hopeless
 
 
 
 
 
3.    Trouble falling or staying asleep‚ or sleeping too much
 
 
 
 
 
4.    Feeling tired or ha‎ving little energy
 
 
 
 
 
5.    Poor appetite or overeating
 
 
 
 
 
6.     Feeling bad about yourself‚ or that you are a failure‚ or have let yourself or your family down
 
 
 
 
 
7.     Trouble concentrating on things‚ such as reading the newspaper or watching television
 
 
 
 
 
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
 
 
 
 
 
9.     Thoughts that you would be better off dead‚ or of hurting yourself in some way
 
 
 
 
 
Scoring
If two consecutive numbers are circled‚ the higher (more distress) number. If the numbers are not consecutive‚ do not the item. is the sum of the 9 items. If more than 1 item missing‚ set the value of the scale to missing. A of 15 or greater is considered major depression‚ 20 or more is severe major depression.
ch‎aracteristics
Tested on 344 subjects with diabetes.
No. of
items
Observed
Range
Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
9
0-23
6.40
5.73
0.88
NA
 
Source of Psychometric Data
English-language Diabetes Self-Management Study (not yet published).
This scale is free to use without permission