Screening & assessment worksheet
PHQ-A — Adolescent Depression Screener
The adolescent adaptation of the PHQ-9, for young people ages 11–17. Nine items scored 0–3, with a safety follow-up on the last item.
Name or initialsDate
How to use this worksheet
For adolescents ages 11–17. If the youth is 18 or older, use the PHQ-9 instead. For each item, check the column that best describes how often it has been a problem over the last 2 weeks. Add the column values (0, 1, 2, 3) for a total score of 0–27, then use the scoring key below. Item 9 is a safety item — any endorsement warrants a direct safety check regardless of the total.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Over the last 2 weeks…
Not at all
(0)
Several days
(1)
More than half the days
(2)
Nearly every day
(3)
1.Little interest or pleasure in doing things
2.Feeling down, depressed, hopeless, or irritable
3.Trouble falling asleep, staying asleep, or sleeping too much
4.Feeling tired or having little energy
5.Poor appetite, weight loss, or overeating
6.Feeling bad about yourself — or feeling that you are a failure, or that you have let yourself or your family down
7.Trouble concentrating on things like school work, reading, or watching TV
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
9.Thoughts that you would be better off dead, or of hurting yourself in some way(safety item)
Score
Total score (add all columns, 0–27):
Scoring key
- 0–4Minimal
- 5–9Mild
- 10–14Moderate
- 15–19Moderately severe
- 20–27Severe
Functional impact
If you checked off any problems, how difficult have these made it to do your school work, take care of things at home, or get along with other people?
Not difficult at allSomewhat difficultVery difficultExtremely difficult
Safety check (required if item 9 is endorsed)
Any response other than “Not at all” on item 9 warrants a direct conversation about safety. Ask about current thoughts, plan, means, and intent, and involve a parent or guardian and the youth's care team as appropriate.
If there is immediate risk, call or text 988 or NH Rapid Response at 833-710-6477.