BRIEF PATIENT HEALTH QESTIONAIRE
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1
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Over the last 2 weeks‚ how often have you been bothered by any of the following problems?
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a. Little interest or pleasure in doing things
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Not
at all
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Several
days
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More than
half the days
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Nearly
every day
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b. Feeling down‚ depressed‚ or hopeless
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c. Trouble falling or staying asleep‚ or sleeping too much
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d. Feeling tired or having little energy
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e. Poor appetite or overeating
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f. Feeling bad about yourself‚ or that you are a failure‚ or have let yourself or your family down
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g. Trouble concentrating on things‚ such as reading the newspaper or watching television
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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
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i. Thoughts that you would be better off dead‚ or of hurting yourself in some way
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2. Questions about anxiety
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NO
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YES
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a. In the last 4 weeks‚ have you had an anxiety attack suddenly feeling fear or panic?
If you checked "NO‚" go to question 3.
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b. Has this ever happened before?
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c. Do some of these attacks come suddenly out of the blue—that is‚ in situations where you don't expect to be nervous or uncomfortable?
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d. Do these attacks bother you a lot or are you worried about having another attack?
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e. During your last bad anxiety attack‚ did you have symptoms like shortness of breath‚ sweating‚ your heart racing or pounding‚ dizziness or faintness‚ tingling or numbness‚ or nausea or upset stomach?
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4. In the last 4 weeks‚ how much have you been bothered by any of the following problems?
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Not
bothered
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Bothered
a little
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Bothered
a lot
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a. Worrying about your health
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b. Your weight or how you look
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c. Little or no sexual desire or pleasure during sex
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d. Difficulties with husband/wife‚ partner/lover‚ or boyfriend/girlfriend
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e. The stress of taking care of children‚ parents‚ or other family members
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f. Stress at work outside of the home or at school
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g. Financial problems or worries
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h. having no one to turn to when you have a problem
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i. Something bad that happened recently
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j. Thinking or dreaming about something terrible that happened to you in the past—like your house being destroyed‚ a severe accident‚ being hit or assaulted‚ or being forced to commit a sexual act
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5. In the last year‚ have you been hit‚ slapped‚ kicked‚ or otherwise physically hurt by someone‚ or has anyone forced you to have an unwanted sexual act?
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NO
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YES
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7. Are you taking any medication for anxiety‚ depression‚ or stress?
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NO
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YES
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a. Which best describes your menstrual periods?
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Periods are unchanged
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No periods because pregnant or recently gave birth
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Periods have become irregular or changed in frequency‚ duration‚ or amount
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No periods for at least a year
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having periods because taking hormone replacement (estrogen) therapy or oral contraceptives
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b. During the week before your period starts‚ do you have a serious problem with your mood—like depression‚ anxiety‚ irritability‚ anger‚ or mood swings?
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NO
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YES
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c. If YES‚ do these problems go away by the end of your period?
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NO
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YES
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d. Have you given birth within the last 6 months?
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NO
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YES
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e. Have you had a miscarriage within the last 6 months?
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NO
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YES
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f. Are you having difficulty getting pregnant?
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NO
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YES
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1
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Over the last 2 weeks‚ how often have you been bothered by any of the following problems?
|
||||
|
|
1. Little interest or pleasure in doing things
|
Not
at all
|
Several
days
|
More than
half the days
|
Nearly
every day
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|
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2. Feeling down‚ depressed‚ or hopeless
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3. Trouble falling or staying asleep‚ or sleeping too much
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4. Feeling tired or having little energy
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|
|
|
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5. Poor appetite or overeating
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6. Feeling bad about yourself‚ or that you are a failure‚ or have let yourself or your family down
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7. Trouble concentrating on things‚ such as reading the newspaper or watching television
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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
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9. Thoughts that you would be better off dead‚ or of hurting yourself in some way
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No. of
items
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Observed
Range
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Mean
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Standard
Deviation
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Internal Consistency
Reliability
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Test-Retest
Reliability
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9
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0-23
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6.40
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5.73
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0.88
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NA
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