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    Questionnaire PDF

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    Aaron Densley
    This document contains several psychological assessment questionnaires, including the PHQ-9 for depression screening, GAD-7 for generalized anxiety disorder screening, and scales to assess phobias, employment status, and the impact of problems on work and social adjustment. Participants are asked to rate how frequently they have experienced various symptoms and problems over the last 2 weeks using a scale from 0 to 3, with higher numbers indicating greater frequency or severity. Their total scores on each assessment will be calculated.

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    Questionnaire PDF

    Uploaded by

    Aaron Densley
    367 views2 pages
    This document contains several psychological assessment questionnaires, including the PHQ-9 for depression screening, GAD-7 for generalized anxiety disorder screening, and scales to assess phobias, employment status, and the impact of problems on work and social adjustment. Participants are asked to rate how frequently they have experienced various symptoms and problems over the last 2 weeks using a scale from 0 to 3, with higher numbers indicating greater frequency or severity. Their total scores on each assessment will be calculated.

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    This document contains several psychological assessment questionnaires, including the PHQ-9 for depression screening, GAD-7 for generalized anxiety disorder screening, and scales to assess phobias, employment status, and the impact of problems on work and social adjustment. Participants are asked to rate how frequently they have experienced various symptoms and problems over the last 2 weeks using a scale from 0 to 3, with higher numbers indicating greater frequency or severity. Their total scores on each assessment will be calculated.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    367 views2 pages

    Questionnaire PDF

    Uploaded by

    Aaron Densley
    This document contains several psychological assessment questionnaires, including the PHQ-9 for depression screening, GAD-7 for generalized anxiety disorder screening, and scales to assess phobias, employment status, and the impact of problems on work and social adjustment. Participants are asked to rate how frequently they have experienced various symptoms and problems over the last 2 weeks using a scale from 0 to 3, with higher numbers indicating greater frequency or severity. Their total scores on each assessment will be calculated.

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    P2 – Local Patient\t Identifier

    PHQ- 9
    Over the last 2 weeks, how often have you been bothered by any More Nearly
    Several
    of the following problems? Not at all than half every
    days
    the days day

    1 Little interest or pleasure in doing things 0 1 2 3

    2 Feeling down, depressed, or hopeless 0 1 2 3

    3 Trouble falling or staying asleep, or sleeping too much 0 1 2 3

    4 Feeling tired or having little energy 0 1 2 3

    5 Poor appetite or overeating 0 1 2 3

    Feeling bad about yourself — or that you are a failure or have let
    6 0 1 2 3
    yourself or your family down
    Trouble concentrating on things, such as reading the newspaper or
    7 0 1 2 3
    watching television
    Moving or speaking so slowly that other people could have noticed?
    8 Or the opposite — being so fidgety or restless that you have been 0 1 2 3
    moving around a lot more than usual
    Thoughts that you would be better off dead or of hurting yourself in
    9 0 1 2 3
    some way
    A11 – PHQ9 total score

    GAD-7
    Over the last 2 weeks, how often have you been bothered by any More Nearly
    Several
    of the following problems? Not at all than half every
    days
    the days day

    1 Feeling nervous, anxious or on edge 0 1 2 3

    2 Not being able to stop or control worrying 0 1 2 3

    3 Worrying too much about different things 0 1 2 3

    4 Trouble relaxing 0 1 2 3

    5 Being so restless that it is hard to sit still 0 1 2 3

    6 Becoming easily annoyed or irritable 0 1 2 3

    7 Feeling afraid as if something awful might happen 0 1 2 3

    A12 – GAD7 total score

    IAPT Phobia Scales


    Choose a number from the scale below to show how much you would avoid each of the situations or objects
    listed below. Then write the number in the box opposite the situation.
    0 1 2 3 4 5 6 7 8
    Would not Slightly Definitely Markedly Always
    avoid it avoid it avoid it avoid it avoid it

    A17 Social situations due to a fear of being embarrassed or making a fool of myself

    Certain situations because of a fear of having a panic attack or other distressing symptoms (such
    A18
    as loss of bladder control, vomiting or dizziness)

    Certain situations because of a fear of particular objects or activities (such as animals, heights,
    A19
    seeing blood, being in confined spaces, driving or flying).
    P2 – Local Patient\t Identifier

    IAPT Employment Status Questions

    A14 - Please indicate which of the following options best describes your current status:

    Employed (Full time)


    Employed (Part time)
    Employed (Self)
    Unemployed (Seeking Work)
    Unemployed
    Benefits
    Student (Full time)
    Student (Part time)
    Homemaker
    Volunteer
    Retired

    A15 - Are you currently receiving Statutory Sick Pay?

    Yes
    No
    Not Known

    A16 - Are you suitable for or feel you would benefit from receiving employment support?

    Yes
    No

    Work and Social Adjustment

    People's problems sometimes affect their ability to do certain day-to-day tasks in their lives. To rate your problems
    look at each section and determine on the scale provided how much your problem impairs your ability to carry out the
    activity.

    1. WORK - if you are retired or choose not to have a job for reasons unrelated to your problem, please tick N/A (not
    applicable)

    0 1 2 3 4 5 6 7 8 N/A
    Not at all Slightly Definitely Markedly Very severely,
    I cannot work

    2. HOME MANAGEMENT – Cleaning, tidying, shopping, cooking, looking after home/children, paying bills etc

    0 1 2 3 4 5 6 7 8
    Not at all Slightly Definitely Markedly Very severely

    3. SOCIAL LEISURE ACTIVITIES - With other people, e.g. parties, pubs, outings, entertaining etc.

    0 1 2 3 4 5 6 7 8
    Not at all Slightly Definitely Markedly Very severely

    4. PRIVATE LEISURE ACTIVITIES – Done alone, e.g. reading, gardening, sewing, hobbies, walking etc.

    0 1 2 3 4 5 6 7 8
    Not at all Slightly Definitely Markedly Very severely

    5. FAMILY AND RELATIONSHIPS – Form and maintain close relationships with others including the people that I
    live with

    0 1 2 3 4 5 6 7 8
    Not at all Slightly Definitely Markedly Very severely

    A13 – W&SAS total score

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