1. Over the last 2 weeks, how often have you been bothered by any of the following problems?
a. Little interest or pleasure in doing things.
Not at all
More than half the days
Nearly every day
b. Feeling down, depressed, or hopeless.
c. Trouble falling asleep, sleeping too much.
d. Feeling tired or having little energy.
e. Poor appetite or overeating.
f. Feeling bad about yourself – or that you are a failure or have let yourself or your family down.
g. Trouble concentrating on things, such as reading the newspaper or watching television.
h. 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.
i. Thoughts that you would be better off dead or of hurting yourself in some way.
2. If you checked off any problem on this questionnaire so far, 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?