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Gad7 PHQ9

The document is a Patient Health Questionnaire-9 (PHQ9) and Generalized Anxiety Disorder 7-item Scale (GAD7) used to assess mental health issues over the past two weeks. It includes questions regarding symptoms of depression and anxiety, with scoring options for frequency and difficulty in daily activities. Patients are required to fill in personal information and indicate the severity of their symptoms.

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healingfocused08
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59 views1 page

Gad7 PHQ9

The document is a Patient Health Questionnaire-9 (PHQ9) and Generalized Anxiety Disorder 7-item Scale (GAD7) used to assess mental health issues over the past two weeks. It includes questions regarding symptoms of depression and anxiety, with scoring options for frequency and difficulty in daily activities. Patients are required to fill in personal information and indicate the severity of their symptoms.

Uploaded by

healingfocused08
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Today's Date:____________________

Patient Name: ____________________________________________ Date of Birth: __________________________

Patient Health Questionnaire-9 (PHQ9)


Over the last 2 weeks, how often have you been bothered by any of the
More than Nearly
following problems ?
Not at all Several days half the days every day

Little interest or pleasure in doing things 0 1 2 3

Feeling down, depressed or hopeless 0 1 2 3

Trouble falling / staying asleep, or sleeping too much 0 1 2 3

Feeling tired or having little energy 0 1 2 3

Poor appetite or overeating 0 1 2 3


Feeling bad about yourself - or that you are a failure or have let yourself
0 1 2 3
or your family down
Trouble concentraiting on things, such as reading the news or watching
0 1 2 3
television
Moving or speaking so slowly that other people could have noticed?
Or the opposite- being so fidgety or restless that you have been 0 1 2 3
moving around a lot more than usual
Thoughts that you would be better off dead or hurting yourself in some
0 1 2 3
way
Score: + + +
Total Score:
Not Difficult Somewhat Extremely
If you checked off any problems, how difficult have these problems
At All Difficult Very Difficult Difficult
made it for you to do your work, take care of things at home or get
along with other people? ⃝ ⃝ ⃝ ⃝

Generalized Anxiety Disorder 7-item Scale (GAD7)


More than
Over the last 2 weeks, how often have you been bothered by any of the half the Nearly
following problems Not at all Several days days every day
Feeling nervous, anxious or on edge 0 1 2 3
Not being being able to stop or control worrying 0 1 2 3
Worrying too much about different things 0 1 2 3
Trouble relaxing 0 1 2 3
Being so restless that it's hard to sit still 0 1 2 3
Becoming easily annoyed or irritable 0 1 2 3
Feeling afraid as if something awful might happen 0 1 2 3
Score: + + +
Total Score:
If you checked off any problems, how difficult have these problems Not Difficult Somewhat Extremely
Very Difficult
At All Difficult Difficult
made it for you to do your work, take care of things at home or get
along with other people? ⃝ ⃝ ⃝ ⃝

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