Quality of Life and PHQ9 Scales Name * First Name Last Name Write any number between 0 and 100 that describes your quality of life: 100 Perfect quality of life 95 Nearly perfect quality of life 90 85 Very good quality of life 80 75 70 Good quality of life 65 60 55 Moderately good quality of life 50 45 40 Somewhat bad quality of life 35 30 Bad quality of life 25 20 15 Very bad quality of life 10 5 Extremely bad quality of life 0 No quality of life Over the last 2 weeks, how often have you been bothered by the following problems? * 1. Little interest or pleasure in doing things 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day 2. Feeling down, depressed or hopeless 0 Not at all 1 Several Days 2 More than half the days 3 Nearly every day 3. Trouble falling asleep, staying asleep, or sleeping too much 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day 4. Feeling tired or having little energy 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day 5. Poor appetite or overeating 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day 6.Feeling bad about yourself - or that you’re a failure or have let yourself or your family down 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day 7. Trouble concentrating on things, such as reading the newspaper or watching television 0 Not at all 1 Several days 2 More than half the days 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 have been moving around a lot more than usual 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day 9. Thoughts that you would be better off dead or of hurting yourself in some way 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day Anything else you'd like us to know? * Thank you!
