Anxiety and Depression Screening
GAD-7 & PHQ-9 (English)
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PERSONAL INFORMATION
What is your name?
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GAD-7 QUESTIONNAIRE
Instructions: CHECK the answer that best applies to you. Please answer each question as best you can.
Over the last 2 weeks, how often have you been bothered by the following problems?
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly everyday (3)
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritated
7. Feeling afraid as if something awful might happen
8. If you checked off any problems, 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
When did symptoms begin?
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PHQ-9 QUESTIONNAIRE
Instructions: CHECK the answer that best applies to you. Please answer each question as best you can.
Over the last 2 weeks, how often have you been bothered by the following problems?
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly everyday (3)
1. Little interest or pleasure in doing things.
2. Feeling down, depressed, or hopeless.
3. Trouble falling or staying asleep, or sleeping too much.
4. Trouble relaxing
5. Poor appetite or over eating.
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down.
7. Trouble concentrating on things, such as reading the newspaper or watching television.
8. 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.
9. Thoughts that you would be better off dead, or of hurting yourself.
10. If you checked off any problems, 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
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