PHQ-9 modified for Adolescents (PHQ-A)

Instructions: How often have you been bothered by each of the following symptoms during the past two weeks? For each symptom put an “X” in the box beneath the answer that best describes how you have been feeling.

1. Feeling down, depressed, irritable, or hopeless? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
2. Little interest or pleasure in doing things? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
3. Trouble falling asleep, staying asleep, or sleeping too much? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
4. Poor appetite, weight loss, or overeating? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
5. Feeling tired, or having little energy? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
6. Feeling bad about yourself – or feeling that you are a failure, or that you have let yourself or your family down? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
7. Trouble concentrating on things like school work, reading, or watching TV? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you were moving around a lot more than usual? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
9. Thoughts that you would be better off dead, or of hurting yourself in some way? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
10. In the past year have you felt depressed or sad most days, even if you felt okay sometimes? a. (0) Not at all b. (1) Several days c. (2) More than half the days d. (3) Nearly every day
11. If you are experiencing any of the problems on this form, how difficult have these problems made it for you to do your work, take care of things at home or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult
12. Office use only: Severity score:
13. Johnson JG, Harris ES, Spitzer RL, Williams JB. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002;30(3):196-204. doi:10.1016/s1054-139x(01)00333-0

Ask Suicide-Screening Questions (ASQ)

Ask the patient:

1. In the past few weeks, have you wished you were dead? Yes No
2. In the past few weeks, have you felt that you or your family would be better off if you were dead? Yes No
3. In the past week, have you been having thoughts about killing yourself? Yes No
4. Have you ever tried to kill yourself? Yes No
   If yes, how?
   
   When?
   
   If the patient answers yes to any of the above, ask the following question:
5. Are you having thoughts of killing yourself right now? Yes No
   If yes, please describe: