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Appendix F: Patient Health Questionnaire (PHQ-9)
Resident: Identifier: Date:
Section D
D0100. Should Resident Mood Interview be Conducted? → Attempt to conduct
interview with all residents
Enter code 0. No (resident is rarely/never understood) → Skip to and complete
D0500-D0600, Staff Assessment of Resident Mood (PHQ—9—OV)
1. Yes → Continue to D0200, Resident Mood Interview (PHQ—9©)
D0200. Resident Mood Interview (PHQ—9©)
Say to resident: "Over the last 2 weeks, have you been bothered by any of the following
problems?"
If symptom is present, enter 1 (yes) in column 1, Symptom Presence.
If yes in column 1, then ask the resident: "About how oen have you been bothered by
this?"
Read and show the resident a card with the symptom frequency choices. Indicate
response in column 2, Symptom Frequency.
1. Symptom Presence
0. No (enter 0 in column 2)
1. Yes
(enter 0–3 in column 2)
9. No response (leave
column 2 blank)
2. Symptom Frequency
0. Never or 1 day
1. 2–6 days (several days)
2. 7–11 days
(half or more of the days)
3. 12–14 days
(nearly every day)
1.
Symptom
Presence
2.
Symptom
Frequency
⬇ Enter Scores ⬇
A. Little interest or pleasure in doing things
B. Feeling down, depressed, or hopeless
C. Trouble falling or staying asleep, or sleeping too much
D. Feeling tired or having little energ y
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. States that life isn't worth living, wishes for death, or
attempts to harm self
J. Being short-tempered, easily annoyed
