Depression Screening

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

Please note, all fields are required.

1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed
9. Thoughts that you would be better off dead, or of hurting yourself
Your response to this question indicates you may be at risk for harming yourself or someone else. Are you in crisis? Please call 911 or the National Suicide Prevention Hotline at 1-800-273-TALK or go immediately to the nearest emergency room.
10. If you checked off any problems, how difficult have these problems made it for you at work, home, or with other people?