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Mental Health Screening PHQ-9 + GAD-7
Personal Details
Full name
*
Email
*
Age (Years)
*
Section A: Patient Health Questionnaire-9 (PHQ-9)
Over the past 2 weeks, you have little interest or pleasure in doing things
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you feel down, depressed, or hopeless
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you have trouble falling or staying asleep, or sleeping too much
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you felt tired or have little energy
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you have poor appetite or is overeating
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you felt bad about yourself—or that you are a failure or have let yourself or your family down
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you have trouble concentrating on things, such as reading the newspaper or watching television
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you move or speak so slowly that other people notice the change. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you thoughts that you would be better off dead or of hurting yourself in some way
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Section B: Generalised Anxiety Disorder-7 Questionnaire (GAD-7)
Over the past 2 weeks, you have been feeling nervous, anxious or on edge
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you are not able to stop or control worrying
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you worry too much about different things
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you have trouble relaxing
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you were being so restless that it is hard to sit still
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you are becoming easily annoyed or irritable
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Over the past 2 weeks, you are feeling afraid as if something awful might happen
*
A
Not at all
B
Several days
C
More than half the days
D
Nearly every day
Submit
