| Thoughts and Feelings |
|---|
| 1. Feeling sad or down in the dumps |
| 2. Feeling unhappy or blue |
| 3. Crying spells or tearfulness |
| 4. Feeling discouraged |
| 5. Feeling hopeless |
| 6. Low self-esteem |
| 7. Feeling worthless or inadequate |
| 8. Guilt or shame |
| 9. Criticizing yourself or blaming yourself |
| 10. Difficulty making decisions |
| Activities and Personal Relationships |
| 11. Loss of interest in family, friends or colleagues |
| 12. Loneliness |
| 13. Spending less time with family or friends |
| 14. Loss of motivation |
| 15. Loss of interest in work or other activities |
| 16. Avoiding work or other activities |
| 17. Loss of pleasure or satisfaction in life |
| Physical Symptoms |
| 18. Feeling tired |
| 19. Difficulty sleeping or sleeping too much |
| 20. Decreased or increased appetite |
| 21. Loss of interest in sex |
| 22. Worrying about your health |
| Suicidal Urges |
| 23. Do you have any suicidal thoughts? |
| 24. Would you like to end your life? |
| 25. Do you have a plan for harming yourself? |
| 0 - 4 |
|---|
0 - Not at all
1 - Somewhat
2 - Moderately
3 - A lot
4 - Extremely
0 - 5 - No depression
6 - 10 - Normal but unhappy
11 - 25 - Mild depression
26 - 50 - Moderate depression
51 - 75 - Severe depression
76 - 100 - Extreme depression