The following questionnaire is not meant to provide a formal diagnosis, however a high score would indicate the need for further examination and possible treatment.
RATING DEPRESSION
Over the past two weeks, how often have you been bothered by any of the following problems? Please click the check box that most applies to you.
0 – Not at all
1 – Several days
2 – More than half of the days
3 – Nearly every 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
……………………………………………………………………………………………………….
6) Feeling bad about yourself, or that you are a failure and have let yourself or your family down:
0 1 2 3
……………………………………………………………………………………………………….
7) Trouble concentrating on things, such as reading the newspaper or watching TV:
0 1 2 3
……………………………………………………………………………………………………….
8) Moving or speaking so slowly that other people can notice. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual:
0 1 2 3
……………………………………………………………………………………………………….
9) Thoughts that you would be better off dead, or hurting yourself in some way:
0 1 2 3
……………………………………………………………………………………………………….
Add Columns:
0 ____ 1 ____ 2 ____ 3____
Score: Total = ____
Results: 1-4: Minimal depression
5-9: Mild depression
10-14: Moderate depression
15-19: Moderately severe depression
20-27: Severe depression
