Over the past 2 weeks, how often have you felt...
1. Closer to your bigger life goals and aspirations
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
2. A sense of balance in each day
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
3. Focused on what matters most to you
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
4. Fulfilled at the end of the day
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
5. Confident in who you are / the person you’re becoming
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
6. Energized by your daily activities
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
7. Moments of genuine happiness throughout the day
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
8. Grateful for what you have in life
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
9. Closer to the person you aspire to be
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
10. Productive toward your daily goals and tasks
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
11. Confident in the direction that your life is going
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
12. Excited by things to look forward to
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Select Answer 0 - Never 1 - Rarely 2 - Sometimes 3 - Half the time 4 - Very often 5 - Almost every day
13. Little interest or pleasure in doing things?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
14. Feeling down, depressed, or hopeless?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
15. Trouble falling or staying asleep, or sleeping too much?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
16. Feeling tired or having little energy?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
17. Poor appetite or overeating?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
18. Feeling bad about yourself - or that you are a failure or have let yourself or your family down?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
19. Trouble concentrating on things, such as reading the newspaper or watching television?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
20. Moving or speaking so slowly that other people could have noticed OR being so fidgety or restless that you have been moving around a lot more than usual?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
21. Thoughts that you would be better off dead, or of hurting yourself in some way?
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Select Answer 0 - Not at all 1 - Several days 2 - More than half the days 3 - Nearly every day
End of PHQ-9 By Pfizer Inc.
Age
Gender
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Gender Female Male Non-binary Prefer not to answer
Marital Status
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Marital Status Single, never married Married or domestic partnership Divorced or separated Widowed Prefer not to answer
Employment
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Employment Employed for wages Self-employed Student Homemaker Military Retired Unable to work Unemployed Prefer not to answer
Ethnicity
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Ethnicity Asian / Pacific Islander Black or African American Hispanic or Latino Native American / American Indian White Other Prefer not to answer
Education
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Education No schooling completed Nursery school to 8th grade Some high school, no diploma High school graduate, diploma or the equivalent Some college credit, no degree Trade/technical/vocational training Associate degree Bachelor’s degree Master’s degree Professional degree Doctorate degree Prefer not to answer
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