Mental Health Review Step 1 of 2 50% Contact DetailsName First Name Surname Date Day Month Year Contact NumberEmail Enter Email Confirm Email Home Address Street Address Address Line 2 City Postcode PHQ9Over the last two weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things Not at all Several days More than half the days Nearly every day Feeling down, depressed, or hopeless Not at all Several days More than half the days Nearly every day Trouble falling or staying asleep, or sleeping too much Not at all Several days More than half the days Nearly every day Feeling tired or having little energy Not at all Several days More than half the days Nearly every day Poor appetite or overeating Not at all Several days More than half the days Nearly every day Feeling bad about yourself, or that you are a failure or have let yourself or your family down Not at all Several days More than half the days Nearly every day Trouble concentrating on things, such as reading the newspaper or watching television Not at all Several days More than half the days Nearly every day Moving or speaking so slowly that other people could have noticed Not at all Several days More than half the days Nearly every day (Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual)Thoughts that you would be better off dead, or of hurting yourself in some way Not at all Several days More than half the days Nearly every day ScoreSeverity Score0-4 = None 5-9 = Mild 10-14 = Moderate 15-19 = Moderately severe 20-27 = SevereFinallyIf you have 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 Optional Somewhat difficult Optional Very difficult Optional Extremely difficult Optional GAD7 Over the last 2 weeks, how often have you been bothered by any of the following problems: Feeling nervous, anxious or on edge Not at all Several days More than half the days Nearly every day Not being able to stop or control worrying Not at all Several days More than half the days Nearly every day Worrying too much about different things Not at all Several days More than half the days Nearly every day Trouble relaxing Not at all Several days More than half the days Nearly every day Being so restless that it's hard to sit still Not at all Several days More than half the days Nearly every day Becoming easily annoyed or irritable Not at all Several days More than half the days Nearly every day Feeling afraid as if something awful might happen Not at all Several days More than half the days Nearly every day Score OptionalSeverity Score0-5 = None 6-10 = Mild 11-15 = Moderate 16-21 = SevereIf you checked any of the 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 Optional Somewhat difficult Optional Very difficult Optional Extremely difficult Optional
