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Depression ScreeningTool

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Depression Screening Tool
This is a screening measure to help you determine whether you might have depression that
needs professional attention. This screening tool is not designed to make a diagnosis of
depression but to be shared with your primary care physician or mental health professional to
inform further conversations about diagnosis and treatment.
Directions:
1. Complete the provided form
2. Print out the results
3. Share them with your health care provider to determine a diagnosis
Over the last two weeks, how often have you been bothered by any of the following
problems?
Not at all
Several days
More than half
of the days
Nearly every day
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

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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? Or the
oppositebeing
so fidgety or
restless that you
have been
moving around a
lot more than
usual
9. Thoughts
that you would
be better off
dead or of
hurting yourself
in some way
If you clicked on any problems above, how difficult have they made it for you to do your
work, take care of things at home, or get along with other people?
Not difficult at all Somewhat difficult Very difficult Extremely difficult

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Depression Screening Tool This is a screening measure to help you determine whether you might have depression that needs professional attention. This screening tool is not designed to make a diagnosis of depression but to be shared with your primary care physician or mental health professional to inform further conversations about diagnosis and treatment. Directions: 1. Complete the provided form 2. Print out the results 3. Share them with your health care provider to determine a diagnosis Over the last two weeks, how often have you been bothered by any of the following problems? 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 Not at all Several days Nearly every day ☐ More than half of the days ☐ ☐ ☐ ☐ ...
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