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Self assessment questionnaires

Self Assessment Questionnaires

Patient Health Questionnaire (PHQ-9)

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

a) Little interest or pleasure in doing things?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

b) Feeling down, depressed, or hopeless?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

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

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

d) Feeling tired or having little energy?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

e) Poor appetite or overeating?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

f) 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 of the days – 2
  • Nearly everyday – 3

g) Trouble concentrating on things, such as reading the newspaper or watching television?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

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?

  • Not at all – 0
  • Several days – 1
  • More than half of the days – 2
  • Nearly everyday – 3

i) 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 of the days – 2
  • Nearly everyday – 3

Total – ___/27

Depression Severity: 0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.

GENERALIZED ANXIETY DISORDER QUESTIONAIRE – SELF REPORT VERSION

SYMPTOMS/SIGNSNOT AT ALLSOMEWHAT DIFFICULTVERY DIFFICULTEXTREMELY DIFFICULT
  1. EXCESSIVE ANXIETY OR WORRY ABOUT A NUMBER OF EVENTS AND ACTIVITIES?
0123
2. FINDING IT DIFFICULT TO CONTROL WORRYING?0123
3. FEELING RESTESS, KEYED UP OR ON EDGE?0123

 

4. BEING EASILY FATIGUED?

 

0123
5.DIFFICULTY CONCENTRATING OR MIND GOING BLANK?0123
6. BEING IRRITABLE?

 

0123
7. FEELING MUSCLE TENSION?

 

0123
8. HAVING DISTURBED SLEEP LIKE DIFFICULTY FALLING ASLEEP, STAYING ASLEEP OR HAVING RESTLESS, UNREFRESHING SLEEP?0123
9. FEELING DISTRESSED BECAUSE OF THESE PROBLEMS?0123
10. HOW DIFFICULT THESE PROBLEMS MADE IT FOR YOU TO DO YOUR WORK, TAKE CARE OF THINGS AT HOME OR GET ALONG WITH OTHER PEOPLE?0123
TOTAL SCORE

 

 Scoring: Clinical anxiety    ≥ 10(mild)      ≥15(moderate),     ≥ 20 (severe)