Directions to Patient:
Please choose the best answer for how you have felt over the past week
Directions to Examiner:
Present questions VERBALLY. Circle answer given by patient. Do not show to patient.
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Have you dropped many of your activities and interests?
Do you feel that your life is empty?
Do you often get bored
Are you hopeful about future?
Are you bothered by thoughts you can't get out of your head?
Are you in good spirit most of the time?
Are you afraid that something bad is going to happen to you?
Do you feel happy most of the time?
Do you often feel helpless?
Do you often get restless and fidgety?
Do you prefer to stay at home rather than go out and do things?
Do you frequently worry about the future?
Do you feel you have more problems with memory than most?
Do you thimk it is wonderful to be alive now?
Do you feel downhearted and blue?
Do you feel pretty worthless the way you are now?
Do you worry a lot about the past?
Do you find life very exciting?
Is it hard for you to get started on new projects?
Do you feel full of energy?
Do you feel that your situation is hopeless?
Do you feel that most people are better off than you are?
Do you frequently get upset over little things?
Do you frequently feel like crying?
Do you have trouble concentrating?
Do you enjoy getting up in the morning?
Do you prefer to avoid social occasions?
Is it easy for you to make decisions?
Is your mind as clear as it used to be?
yes(1)
yes(1)
yes(1)
yes
yes(1)
yes
yes(1)
yes
yes(1)
yes(1)
yes(1)
yes(1)
yes(1)
yes
yes(1)
yes(1)
yes(1)
yes
yes(1)
yes
yes(1)
yes(1)
yes(1)
yes(1)
yes(1)
yes
yes(1)
yes
yes
no
no
no
no(1)
no
no(1)
no
no(1)
no
no
no
no
no
no(1)
no
no
no
no(1)
no
no(1)
no
no
no
no
no
no(1)
no
no(1)
no(1)
TOTAL: Please sum all the ones (1) for total score._____________________________
Scores: 0-9 Normal 10-19 Mild Depressive 20-30 Severe Depressive