Depression Questionnaire

Depression Questionnaire: Score each question from 0-3 with 0 being never- very infrequently experience to 3 being experience it significantly

QUESTION/SYMPTOM	TIME OF YEAR	YOUR RESPONSE
Do you have difficulty waking up in the morning?	Any time of the year
Do you have reduced energy and feel very sluggish?	Any time of the year
Do you crave carbs ( i.e. sweets, breads & pasta)?	Any time of the year
Do you have a change in appetite?	Any time of the year
Do you have sleep difficulties including needing to sleep more?	Any time of the year
Do you have a change in weight?	Any time of the year
Do you have difficulties concentrating?	Any time of the year
Do you have a reduced libido? (interest in sex)	Any time of the year
Would you rather spend time on your own versus time with family or friends?	Any time of the year
Do you feel sad or depressed often?	Any time of the year
Do you feel sensitive, anxious, irritable or agitated?	Any time of the year
Have you lost interest or pleasure in activities, even those you would normally enjoy?	Any time of the year
Do you feel like you are moving in slow motion?	Any time of the year
Do you have poor concentration or indecisiveness?	Any time of the year
Do simple tasks seem difficult?	Any time of the year
Do you have feelings of worthlessness, or excessive or inappropriate guilt?	Any time of the year
Do you have recurrent thoughts of death? (not usually fear of death, but more a preoccupation with death & dying, i.e. thoughts of “ life’s not worth living” or “ I don’t care if I wake up”	Any time of the year
YOUR TOTAL SCORE

Your Evaluation:

• If your total score is 0-17 and you have less than 5 of the above symptoms there is a low risk that you have clinical depression
• If your total score is 18-35 there is a moderate risk that you may be experiencing clinical depression. It is recommended that you follow up with your health care team for proper assessment and support.
• If your total score is 36-51 there is a high risk that you may be experiencing clinical depression. It is recommended that you follow up with your health care team for proper assessment and support.

There is a high risk of having clinical depression if you also have any of the following:

• If you have 5 or more of the above symptoms, with at least one highlighted symptom
• Your symptoms impair your normal day to day activities including work
• Your symptoms are present most of the time on most days and have lasted at least two weeks
• Your symptoms are often worse first thing each day
• You have many generalized symptoms as well such as headaches, palpitations, chest pains and general aches
• These symptoms are not due to a medication side-effect, or due to drug or alcohol misuse, or to a physical condition such as an under active thyroid, low iron or hormone imbalance.

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