How Are You Feeling?

Indicate your agreement with each item below by checking the appropriate box. Please be open and honest in your responses.

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

Not at allSeveral daysMore than half the daysNearly
every day
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.