Depression Measure Worksheet

Severity Measure for Depression—Adult*

Name*
Age*
Sex:*
- Male
- Female
Date*
MM slash DD slash YYYY
Over the last 7 days, how often have you been bothered by any of the following problems?
Input the value that best fits you, (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day.
Little interest or pleasure in doing things. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
Feeling down, depressed, or hopeless. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
Trouble falling or staying asleep, or sleeping too much. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
Feeling tired or having little energy. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
Poor appetite or overeating. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
Feeling bad about yourself - or that you are a failure or have let yourself or your family down. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
Trouble concentrating on things, such as reading the newspaper, or watching television. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
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. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
Thoughts that you would be better off dead or of hurting yourself in some way. (0) Not at all, (1) Several days, (2) More than half the days, (3) Nearly every day*
Please enter a number from 0 to 3.
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Raw Score