Depression Assessment

This easy to use patient questionnaire has been validated for use in Primary Care. It is used by your doctor to monitor the severity of depression and response to treatment. It can also be used to make a tentative diagnosis of depression.

Depression Assessment

Depression Assessment

DD/MM/YYYY
Please let us know your preferred contact number in case we need to contact you.

Over the last two weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things:
Feeling down, depressed, or hopeless:
Trouble falling or staying asleep, or sleeping too much:
Feeling tired or having little energy:
Poor appetite or overeating:
Feeling bad about yourself, or that you are a failure or have let yourself or your family down:
Trouble concentrating on things, such as reading the newspaper or watching television:
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 :
Thoughts that you would be better off dead, or of hurting yourself in some way:
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?
This will be automatically calculated, for practice use only.