PHQ-15 · Cuestionario sobre síntomas físicos

Patient InformationInformación del paciente

Patient NameNombre del pacienteDate of BirthFecha de nacimientoToday’s DateFecha de hoy

During the past 4 weeks, how much have you been bothered by any of the following problems?Durante las últimas 4 semanas, ¿cuánta molestia ha tenido por cualquiera de los siguientes problemas?

0 of 15 items answered

aStomach painDolor de estómago

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

bBack painDolor de espalda

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

cPain in your arms, legs, or joints (knees, hips, etc.)Dolor en sus brazos, piernas o coyunturas (rodillas, caderas, etc.)

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

dMenstrual cramps or other problems with your periodsCalambres menstruales u otros problemas con sus períodos

WOMEN ONLYSOLO MUJERES

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestiaN/ANot applicableNo aplica

eHeadachesDolores de cabeza

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

fChest painDolores en el pecho

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

gDizzinessMareos

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

hFainting spellsEpisodios de desmayos

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

iFeeling your heart pound or raceHa sentido su corazón palpitar o acelerarse

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

jShortness of breathCorto(a) de respiración

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

kPain or problems during sexual intercourseDolor o problemas durante la penetración sexual

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

lConstipation, loose bowels, or diarrheaEstreñimiento, intestino suelto o diarrea

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

mNausea, gas, or indigestionNáusea, gas o indigestión

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

nFeeling tired or having low energySe ha sentido cansado(a) o con poca energía

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

oTrouble sleepingHa tenido dificultad para dormir

0Not bothered at allSin molestia1Bothered a littleUn poco de molestia2Bothered a lotMucha molestia

Total ScorePuntuación total— / 30

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