1 – Not at all or Less than 1 day
2 – 1–2 days
3 – 3–4 days
4 – 5–7 days
5 – Nearly every day for 2 weeks
¹
1
2
3
4
5
1
My appetite was poor.
2
I could not shake off the blues.
3
I had trouble keeping my mind on what I was doing.
4
I felt depressed.
5
My sleep was restless.
6
I felt sad.
7
I could not get going.
8
Nothing made me happy.
9
I felt like a bad person.
10
I lost interest in my usual activities.
11
I slept much more than usual.
12
I felt like I was moving too slowly.
13
I felt fidgety.
14
I wished I were dead.
15
I wanted to hurt myself.
16
I was tired all the time.
17
I did not like myself.
18
I lost a lot of weight without trying to.
19
I had a lot of trouble getting to sleep.
20
I could not focus on the important things.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.