Depression Self-Assessment Over the last 2 weeks, on how many days have you been bothered by any of the following problems? Url Question 1 Little interest or pleasure in doing things? Thoughts that you would be better off dead or hurting yourself in some way? Not at all Several days More than half the days Nearly every day Question 2 Feeling down, depressed or hopeless? Feeling down, depressed or hopeless? Not at all Several days More than half the days Nearly every day Question 3 Trouble falling asleep or staying asleep, or sleeping too much? Trouble falling asleep or staying asleep, or sleeping too much? Not at all Several days More than half the days Nearly every day Question 4 Feeling tired or having little energy? Feeling tired or having little energy? Not at all Several days More than half the days Nearly every day Question 5 Poor appetite or over eating? Poor appetite or over eating? Not at all Several days More than half the days Nearly every day Question 6 Feeling bad about yourself – or that you are a failure or have let yourself or your family down? Feeling bad about yourself – or that you are a failure or have let yourself or your family down? Not at all Several days More than half the days Nearly every day Question 7 Trouble concentrating on things, such as reading the newspaper or watching TV? Trouble concentrating on things, such as reading the newspaper or watching TV? Not at all Several days More than half the days Nearly every day Question 8 Moving or speaking so slowly that other people could have noticed, or the opposite – being so fidgety or restless that you have been moving around a lot more than usual? Moving or speaking so slowly that other people could have noticed, or the opposite – being so fidgety or restless that you have been moving around a lot more than usual? Not at all Several days More than half the days Nearly every day Question 9 Thoughts that you would be better off dead or hurting yourself in some way? Thoughts that you would be better off dead or hurting yourself in some way? Not at all Several days More than half the days Nearly every day First Name Last Name Phone Number Email Address
