IF you have been feeling "down", "blue", or just "out of sorts" for more than just a few
days, and are beginning to be concerned that there is something wrong with you, or in your
life, and are wondering if you are "depressed" -in the truest sense of the word- not just a
"down day", this questionnaire may help you determine if it is time to talk to a health-care
This QUESTIONNAIRE may help identify common symptoms of depression. The results can be a
helpful way to discuss your condition with your health-care provider and actually help him/her
diagnose your condition.
This is not a substitute for a diagnosis of depression by a qualified health-care professional - it is
intended to help you discuss symptoms with a qualified health-care professional. . As with any medical
illness or condition, only your doctor or other qualified health-care professional can provide a diagnosis
If you think you may have depression, you should visit your doctor or other qualified health-care
professional as soon as possible.
Print this questionnaire out, and put a Checkmark beside the items that best describe you over the last
7-14 days. And take the results with you to your Doctor if you decide you need to see her or him, to
I never take longer than 30 minutes to fall asleep.
I take at least 30 minutes to fall asleep, less than half the time.
I take at least 30 minutes to fall asleep, more than half the time.
I take more than 60 minutes to fall asleep, more than half the time.
Sleep During the Night:
I do not wake up at night.
I have a restless, light sleep with a few brief awakenings each night.
I wake up at least once a night, but I go back to sleep easily.
I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.
Waking Up Too Early:
Most of the time, I awaken no more than 30 minutes before I need to get up.
More than half the time I awaken more than 30 minutes before I need to get up.
I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually.
I awaken at least one hour before I need to, and can't go back to sleep.
Sleeping Too Much:
I sleep no longer than 7-8 hours/night, without napping during the day.
I sleep no longer than 10 hours in a 24-hour period including naps.
I sleep no longer than 12 hours in a 24-hour period including naps.
I sleep longer than 12 hours in a 24-hour period including naps.
I do not feel sad.
I feel sad less than half the time.
I feel sad more than half the time.
I feel sad nearly all of the time.
There is no change in my usual appetite.
I eat somewhat less often or lesser amounts of food than usual.
I eat much less than usual and only with personal effort.
I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade
me to eat.
There is no change from my usual appetite.
I feel a need to eat more frequently than usual.
I regularly eat more often and/or greater amounts of food than usual.
I feel driven to overeat both at mealtime and between meals.
Decreased Weight (Within the Last Two Weeks):
I have not had a change in my weight.
I feel as if I've had a slight weight loss.
I have lost 2 pounds or more.
I have lost 5 pounds or more.
Increased Weight (Within the Last Two Weeks):
I have not had a change in my weight.
I feel as if I've had a slight weight gain.
I have gained 2 pounds or more.
I have gained 5 pounds or more.
There is no change in my usual capacity to concentrate or make decisions.
I occasionally feel indecisive or find that my attention wanders.
Most of the time, I struggle to focus my attention or to make decisions.
I cannot concentrate well enough to read or cannot make even minor decisions.
View of Myself:
I see myself as equally worthwhile and deserving as other people.
I am more self-blaming than usual.
I largely believe that I cause problems for others.
I think almost constantly about major and minor defects in myself.
Thoughts of Death or Suicide:
I do not think of suicide or death.
I feel that life is empty or wonder if it's worth living.
I think of suicide or death several times a week for several minutes.
I think of suicide or death several times a day in some detail, or I have made specific plans for suicide
or have actually tried to take my life.
There is no change from usual in how interested I am in other people or activities.
I notice that I am less interested in people or activities.
I find I have interest in only one or two of my formerly pursued activities.
I have virtually no interest in formerly pursued activities.
There is no change in my usual level of energy.
I get tired more easily than usual.
I have to make a big effort to start or finish my usual daily activities (for example, shopping,
homework, cooking or going to work).
I really cannot carry out most of my usual daily activities because I just don't have the energy.
Feeling Slowed Down:
I think, speak, and move at my usual rate of speed.
I find that my thinking is slowed down or my voice sounds dull or flat.
It takes me several seconds to respond to most questions and I'm sure my thinking is slowed.
I am often unable to respond to questions without extreme effort.
I do not feel restless.
I'm often fidgety, wringing my hands, or need to shift how I am sitting.
I have impulses to move about and am quite restless.
At times, I am unable to stay seated and need to pace around.
Klaas Tuinman M.A. (2005)
A Dawn Cove Abbey Support Resource
If you arrived here from the Depression Page, just close this page to return.
|Dawn Cove Abbey
Roadside Assistance For Your Journey Through Life
- Dedicated to helping people return (and maintain) sanity and decency to life -
From the eBook: "One! The Journey hOMe", by Klaas Tuinman MA, © 2007-2017
Questions and comments welcomed.