|
Date:
|
|
|
Over the last 2 weeks:
|
|
|
1. Little interest or pleasure doing things?
|
|
|
2. Feeling down / depressed / hopeless
|
|
|
3. Trouble falling or staying asleep, or sleeping too much?
|
|
|
4. Feeling tired and having little energy?
|
|
|
5. Poor appetite or overeating?
|
|
|
6. Feeling bad about yourself/feeling a failure/feeling you have let people down?:
|
|
|
7. Trouble concentrating on things, such as reading the newspaper/watching television?
|
|
|
8. Moving/Speaking so slow that other people could have noticed/the opposite?
|
|
|
9. Thoughts that you would be better off dead or of hurting yourself in someway?
|
|
|
If you checked off any problems, how DIFFICUT have these problems made it for you?
|
|
|
Total:
|
|
