Mood Questionnaire (PHQ-9)
Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you

Review

Over the last 2 weeks, how often have you been bothered by any of the following problems:

Little interest or pleasure in doing things:
Feeling down, depressed, or hopeless:
Trouble falling or staying asleep, or sleeping too much:
Feeling tired or having little energy:
Poor appetite or overeating:
Feeling bad about yourself — or that you are a failure or have let yourself or your family down:
Trouble concentrating on things, such as reading the newspaper or watching television:
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:
Thoughts that you would be better off dead or of hurting yourself in some way:

For the following situations, please state how likely you are to avoid them using the following scores: 0 – Never avoid it, 2 – Slightly avoid it, 4 – Definitely avoid it, 6 – Markedly avoid it, 8 – Always avoid it.

Social situations due to a fear of being embarrassed or making a fool of myself
Certain situations because of a fear of having a panic attack or other distressing symptoms (such as loss of bladder control, vomiting or dizziness)
Certain situations because of a fear of particular objects or activities (such as animals, heights, seeing blood, being in confined spaces, driving or flying)