Depression Assessment Questionnaire

This questionnaire is used for screening, diagnosing, monitoring and measuring the severity of depression.

First name

Surname

Address

Postcode

Telephone

Mobile

Questionnaire

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling/staying asleep, 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.

If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

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This information is retained for up to 28 days.

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Ashby Turn Primary Care Centre • The Link, Scunthorpe, North Lincolnshire, DN16 2UT.

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Key Information

Depression Assessment Questionnaire

Privacy Protection