This questionnaire is an indication of the level of depression you are feeling
Full Name
*
Email
*
Over the last 2 weeks, how often have you been bothered by any of the following problems?
*
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
Little interest or pleasure in doing things
*
0
1
2
3
Feeling down, depressed, or hopeless
*
0
1
2
3
Trouble falling or staying asleep, or sleeping too much
*
0
1
2
3
Feeling tired or having little energy
*
0
1
2
3
Poor appetite or overeating
*
0
1
2
3
Feeling bad about yourself — or that you are a failure or have let yourself or your family down
*
0
1
2
3
Trouble concentrating on things, such as reading the newspaper or watching television
*
0
1
2
3
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
*
0
1
2
3
Thoughts that you would be better off dead or of hurting yourself in some way
*
0
1
2
3
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
*
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult