PHQ9 & CAGE-AID

Do you have a few minutes to answer a short survey regarding your feelings in the last 2 weeks?

Question Title

* 1. Over the last 2 weeks, how often have you been bothered by any of the following problems?

	Not at all	Several days	More than half the days	Nearly every day
Little interest or pleasure in doing things	Little interest or pleasure in doing things Not at all	Little interest or pleasure in doing things Several days	Little interest or pleasure in doing things More than half the days	Little interest or pleasure in doing things Nearly every day
Feeling down, depressed or hopeless	Feeling down, depressed or hopeless Not at all	Feeling down, depressed or hopeless Several days	Feeling down, depressed or hopeless More than half the days	Feeling down, depressed or hopeless Nearly every day
Trouble falling or staying asleep, or sleeping too much	Trouble falling or staying asleep, or sleeping too much Not at all	Trouble falling or staying asleep, or sleeping too much Several days	Trouble falling or staying asleep, or sleeping too much More than half the days	Trouble falling or staying asleep, or sleeping too much Nearly every day
Feeling tired or having little energy	Feeling tired or having little energy Not at all	Feeling tired or having little energy Several days	Feeling tired or having little energy More than half the days	Feeling tired or having little energy Nearly every day
Poor appetite or overeating	Poor appetite or overeating Not at all	Poor appetite or overeating Several days	Poor appetite or overeating More than half the days	Poor appetite or overeating Nearly every day
Feeling bad about yourself- or that you are a failure or have let yourself or your family down	Feeling bad about yourself- or that you are a failure or have let yourself or your family down Not at all	Feeling bad about yourself- or that you are a failure or have let yourself or your family down Several days	Feeling bad about yourself- or that you are a failure or have let yourself or your family down More than half the days	Feeling bad about yourself- or that you are a failure or have let yourself or your family down Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television	Trouble concentrating on things, such as reading the newspaper or watching television Not at all	Trouble concentrating on things, such as reading the newspaper or watching television Several days	Trouble concentrating on things, such as reading the newspaper or watching television More than half the days	Trouble concentrating on things, such as reading the newspaper or watching television Nearly every day
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	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 Not at all	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 Several days	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 More than half the days	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 Nearly every day
Thoughts that you would be better off dead, or thoughts of hurting yourself	Thoughts that you would be better off dead, or thoughts of hurting yourself Not at all	Thoughts that you would be better off dead, or thoughts of hurting yourself Several days	Thoughts that you would be better off dead, or thoughts of hurting yourself More than half the days	Thoughts that you would be better off dead, or thoughts of hurting yourself Nearly every day

Question Title

* 2. If you checked off ANY PROBLEMS...

	Not difficult at all	Somewhat difficult	Very difficult	Extremely difficult
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?	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	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? Somewhat difficult	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? Very difficult	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? Extremely difficult

Question Title

* 3. If the survey result shows that you need a referral for help, can we contact you to provide you with a referral?

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