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@FaustianReactor
NAME: DATE:
Over the last 2 weeks, how often have you been
bothered by any of the following problems?
(use "ⁿ" to indicate your answer) Not at all Several
days
More than
half the
days
Nearly
every day

1.Litle interest or pleasure in doing things 0 1 2 3

2. Feeling down, depressed, or hopeless 0 1 2 3

3. Trouble falling or staying asleep, or sleeping too much 0 1 2 3

4. Feeling tired or having little energy 0 1 2 3

5. Poor appetite or overeating 0 1 2 3

6. Feeling bad about yourself or that you are a failure or have let yourself or your family down
0 1 2 3

7. Trouble concentrating on things, such as reading the newspaper or watching television
0 1 2 3

8. Moving or speaking so slowly that other people could have noticed. Or the opposite being so figety or restless that you have been moving around a lot more than usual
0 1 2 3

9. Thoughts that you would be better off dead, or of hurting yourself
0 1 2 3
 
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