Session 6 Resources:

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Session 6 PDF

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PHQ GAD WASA

Health Questionnaires

Name
First Last
Date
MM slash DD slash YYYY
First or last session?*
PHQ-9
Over the last 2 weeks how often have you been bothered by any of the following problems:
Little interest or pleasure in doing things*
Not at all Several days More than half the days Nearly every day
Feeling down, depressed or hopeless*
Not at all Several days More than half the days Nearly every day
Trouble falling asleep, staying asleep or sleeping too much*
Not at all Several days More than half the days Nearly every day
Feeling tired or having little energy*
Not at all Several days More than half the days Nearly every day
Poor appetite or overeating*
Not at all Several days More than half the days Nearly every day
Feeling bad about yourself, or that you are a failure or have let yourself or family down*
Not at all Several days More than half the days Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching TV*
Not at all Several days More than half the days 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*
Not at all Several days More than half the days Nearly every day
Thoughts that you would be better off dead or of hurting yourself in some way*
Not at all Several days More than half the days Nearly every day
GENERALISED ANXIETY DISORDER (GAD7)
Over the last 2 weeks how often have you been bothered by any of the following problems
Feeling nervous, anxious or on edge*
Not at all Several days More than half the days Nearly every day
Not being able to stop or control worrying*
Not at all Several days More than half the days Nearly every day
Worrying too much about different things*
Not at all Several days More than half the days Nearly every day
Trouble relaxing*
Not at all Several days More than half the days Nearly every day
Being so restless that it is hard to sit still*
Not at all Several days More than half the days Nearly every day
Becoming easily annoyed or irritable*
Not at all Several days More than half the days Nearly every day
Feeling afraid as if something awful might happen*
Not at all Several days More than half the days Nearly every day
WORK AND SOCIAL ADJUSTMENT
Please rate from 0-8 how much your problem impairs your ability to carry out these day to day tasks
Work*
0 -Not at all 4 -Moderately 8 -Very Severely
Home management – cleaning, shopping, looking after home, children, paying bills etc.*
0 -Not at all 4 -Moderately 8 -Very Severely
Social and leisure activities – with other people, parties, pubs, outings, entertainment*
0 -Not at all 4 -Moderately 8 -Very Severely
Private leisure activities – undertaken alone e.g. reading, gardening, walking, hobbies*
0 -Not at all 4 -Moderately 8 -Very Severely
Family and relationships – form and maintain close relationships with others, including people I live with*
0 -Not at all 4 -Moderately 8 -Very Severely

Thank you, good bye and good luck with your onward journey 🙂

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PHQ GAD WASA

PHQ-9

GENERALISED ANXIETY DISORDER (GAD7)

WORK AND SOCIAL ADJUSTMENT