YES

NO

1.

Do you feel sad or irritable?

2.

Have you lost interest in activities once enjoyed?

3.

Have you experienced changes in weight or appetite?

4.

Have you experienced changes in sleeping pattern?

5.

Do you have feelings of guilt?

6.

Are you unable to concentrate, remember things, or make decisions?

7.

Have you experienced fatigue or loss of energy?

8.

Have you experienced restlessness or decreased activity noticed by others?

9.

Do you feel hopeless, or worthless?

10.

Have you had thoughts of suicide or death?

11.

Do you get very frightened or panicky feelings for apparently no reason at all?

12.

Do you have weeping spells or feel like it?

13.

Do you wake up early and then sleep badly for the rest of the night?

14.

Do you have nagging aches and pains that don't seem to go away?

15.

Do you take longer than other people to eat a meal or do you usually finish before everyone else?

16.

Do you feel the joy and pleasure has gone out of your life?

17.

Is it hard for you to concentrate on reading?

18.

Are you stuck constantly blaming and/or criticizing yourself or others?

19.

Is it hard for you to make decisions?

20.

Are you frequently grumpy, sad, or moody?

21.

Have you lost interest in aspects of life that used to be important to you?