1.
During the past week, including today...
I felt sad or depressed
Sometimes true (3–4 days)
Almost always true (every day)
2. I was not as interested in my usual activities
Sometimes true (3–4 days)
Almost always true (every day)
3. My appetite was poor and I didn't feel like eating
Sometimes true (3–4 days)
Almost always true (every day)
4. My appetite was much greater than usual
Sometimes true (3–4 days)
Almost always true (every day)
5. I had difficulty sleeping
Sometimes true (3–4 days)
Almost always true (every day)
6. I was sleeping too much
Sometimes true (3–4 days)
Almost always true (every day)
7. I felt very fidgety, making it difficult to sit still
Sometimes true (3–4 days)
Almost always true (every day)
8. I felt physically slowed down, like my body was stuck in mud
Sometimes true (3–4 days)
Almost always true (every day)
9. My energy level was low
Sometimes true (3–4 days)
Almost always true (every day)
10. I felt guilty
Sometimes true (3–4 days)
Almost always true (every day)
11. I thought I was a failure
Sometimes true (3–4 days)
Almost always true (every day)
12. I had problems concentrating
Sometimes true (3–4 days)
Almost always true (every day)
13. I had more difficulties making decisions than usual
Sometimes true (3–4 days)
Almost always true (every day)
14. I wished I was dead
Sometimes true (3–4 days)
Almost always true (every day)
15. I thought about killing myself
Sometimes true (3–4 days)
Almost always true (every day)
16. I thought that the future looked hopeless
Sometimes true (3–4 days)
Almost always true (every day)
17.
Overall, how much have symptoms of depression interfered with or caused difficulties in your life during the past week?
18. How would you rate your overall quality of life during the past week?
Very good, my life could hardly be better
Pretty good, most things are going well
The good and bad parts are about equal
Pretty bad, most things are going poorly
Very bad, my life could hardly be worse
The presented answer sheet is not an original form and is not intended for printing or use as a handout.