www.chilhoweeba.org - Depression Rating

If you are worried about depression in your life, please fill out the survey below. If you mark seven or more of the questions as yes, you may want to seek help for depression.

DEPRESSION RATING

NAME: __________________________________________

DATE: ___________________________________________

Place a check mark by the ones that apply to you. This will help in evaluating your depression.

____	1.	I feel like crying more now than I did a year ago.
____	2.	I have lost interest in things I used to enjoy.
____	3.	I feel blue and sad.
____	4.	I feel helpless a good part of the time.
____	5.	I feel that I am not useful or needed.
____	6.	I do not feel that life is worth living.
____	7.	I have trouble sleeping and staying asleep.
____	8.	I am restless and jumpy a lot.
____	9.	I have less energy than usual; I tire easily.
____	10.	I am more irritable than usual.
____	11.	I do not like the way I am.
____	12.	I think a lot about the past.
____	13.	I have more physical problems (headaches, stomachaches, etc.) than I did a year ago.
____	14.	People notice I do not do my job as well as I used to do.
____	15.	I think others would be better off if I were dead.
____	16.	I have lost a lot of my motivation.
____	17.	I am losing weight without trying.
____	18.	I tend to keep things bottled up inside too much.
____	19.	I feel self-conscious around others a lot.
____	20.	I have problems expressing love to others.