Patient: Age: Weight:

Mood PHQ-4


Measure Mood

PHQ-4: Questionnaire for Depression and Anxiety

Completed by:
Patient or Clinician

Purpose:
To screen for anxiety and depression in patients with chronic pain
Note - this is only a screening tool and does not diagnose depression

Questionnaire:
Over the past 2 weeks have you been bothered by these problems? Not at all Several days More days than not Nearly every day
Feeling nervous, anxious or on edge?
0

1

2

3
Not being able to stop or control worrying
0

1

2

3
Feeling down, depressed, or hopeless
0

1

2

3
Little interest or pleasure in doing things
0

1

2

3
The thought of harming myself has occurred to me (choose one):No Yes

Total:

0/12

Scoring:
Total score is determined by adding together the scores for each of the 4 items

How to Interpret Score:
Scores are rated as normal (0-2), mild (3-5), moderate (6-8), and severe (9-12).

Reference: Lowe, B., Wahl, I., Rose, M., Spitzer, C., Glaesmer, H., Wingenfeld, K., Schneider, A., Brahler, E. (2010). A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord, 122(1-2), 86-95.

Link to Article: http://www.sciencedirect.com/science/article/pii/S016503270900278X

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