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Depression Questionnaire

Gather anonymous responses about mood, sleep, and energy to help identify possible signs of depression.

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How often have you felt down, depressed, or hopeless in the past two weeks?

Not at all Several days More than half the days Nearly every day

Have you had little interest or pleasure in doing things in the past two weeks?

Not at all Several days More than half the days Nearly every day

How often have you felt tired or had little energy in the past two weeks?

Not at all Several days More than half the days Nearly every day

Have you had trouble falling asleep, staying asleep, or sleeping too much in the past two weeks?

Not at all Several days More than half the days Nearly every day

How often have you felt a poor appetite or overeating in the past two weeks?

Not at all Several days More than half the days Nearly every day

Have you felt bad about yourself or that you are a failure or have let yourself or your family down in the past two weeks?

Not at all Several days More than half the days Nearly every day

How often have you had trouble concentrating on things, such as reading the newspaper or watching TV in the past two weeks?

Not at all Several days More than half the days Nearly every day

Have you had thoughts that you would be better off dead or of hurting yourself in the past two weeks?

Not at all Several days More than half the days Nearly every day

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