| How true was this for you lately? Rate 0 - 10 |
Frequency |
Intensity |
Duration |
Total |
|
Worry (without reasonable cause) |
|
|
|
|
|
Futility; feelings of uselessness |
|
|
|
|
|
Sad mood (for no reason, over little things) |
|
|
|
|
|
Feelings of hopelessness or pessimism |
|
|
|
|
|
Feelings of helplessness or despair |
|
|
|
|
|
Guilty feelings (for no reason) |
|
|
|
|
|
Dwelling on the past |
|
|
|
|
|
Irritability (angry even over little things) |
|
|
|
|
|
Conviction that your endeavors are meaningless |
|
|
|
|
|
Unable to concentrate, make decisions, study |
|
|
|
|
|
Feeling angry, sullen, bitter, resentful |
|
|
|
|
|
Anxious |
|
|
|
|
|
Decreased thought processes |
|
|
|
|
|
Hypochondria |
|
|
|
|
|
Sense of dread and fear of dying |
|
|
|
|
| How true was this for you lately? Rate 0 - 10 |
Frequency |
Intensity |
Duration |
Total |
|
Change in weight during past two months |
|
|
|
|
|
Fatigue, low level of energy |
|
|
|
|
|
Sleep disturbance, insomnia, early awakenings |
|
|
|
|
|
Confusion, memory lapses |
|
|
|
|
|
Decrease in sex drive |
|
|
|
|
|
Crying spells, or feeling like crying |
|
|
|
|
|
Apathy, loss of motivation |
|
|
|
|
|
Loss of interest in favorite things and activities |
|
|
|
|
|
Poor grooming, sloppy appearance, unkempt |
|
|
|
|
|
Withdrawal, feeling isolated
|
|
|
|
|
|
Loss of sense of humor, difficulty in laughing |
|
|
|
|
|
Introspection and introversion, self-centered |
|
|
|
|
|
Inferiority feelings |
|
|
|
|
|
Feeling unloved, unwanted, unappreciated |
|
|
|
|
|
Feeling worthless |
|
|
|
|
| How true was this for you lately? Rate 0 - 10 |
Frequency |
Intensity |
Duration |
Total |
|
Depersonalization (leaving your body) |
|
|
|
|
|
Lack of warm feelings, emotions, or interests
|
|
|
|
|
|
Fear of rejection & desire to be close |
|
|
|
|
|
Clinging behavior |
|
|
|
|
|
Defensiveness, denial, displacement |
|
|
|
|
|
Paranoid, afraid people are mad at you |
|
|
|
|
|
Masochism (seeking painful experiences) |
|
|
|
|
|
Headaches |
|
|
|
|
|
Back pain |
|
|
|
|
|
Indigestion, constipation, or heartburn |
|
|
|
|
|
Other aches and pains |
|
|
|
|
|
Suicidal thoughts or escape fantasies |
|
|
|
|
|
Cutting on or hurting yourself |
|
|
|
|
|
A plan to commit suicide |
|
|
|
|
|
An attempt to commit suicide |
|
|
|
|
| Total factors selected:
out of 45 |
Total score: |
|
|
Depression Assessment
