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PHQ15

During the past 4 weeks, how much have you been bothered by any of the following problems?

1. 1.Stomach pain.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

2. 2.Back pain.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

3. 3.Pain in your arms, legs or joints.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

4. 4.Menstrual cramps or other problems with your periods (women only).

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

5. 5.Headaches.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

6. 6.Chest pain.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

7. 7.Dizziness.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

8. 8.Fainting spells.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

9. 9.Feeling your heart pound or race.

   • [0]Not bothered at all
   • [1]Bothered a little
   • [2]Bothered a lot

10. 10.Shortness of breath.

    • [0]Not bothered at all
    • [1]Bothered a little
    • [2]Bothered a lot

11. 11.Pain or problems during sexual intercourse.

    • [0]Not bothered at all
    • [1]Bothered a little
    • [2]Bothered a lot

12. 12.Constipation, loose bowels or diarrhea.

    • [0]Not bothered at all
    • [1]Bothered a little
    • [2]Bothered a lot

13. 13.Nausea, gas or indigestion.

    • [0]Not bothered at all
    • [1]Bothered a little
    • [2]Bothered a lot

14. 14.Feeling tired or having low energy.

    • [0]Not bothered at all
    • [1]Bothered a little
    • [2]Bothered a lot

15. 15.Trouble sleeping.

    • [0]Not bothered at all
    • [1]Bothered a little
    • [2]Bothered a lot