The items below refer to how you have felt and behaved during the past week.

Mark each statement from 0 to 5 using the following scale:

1 = not at all     2=a tiny bit    3=sometimes    4=usually    5=absolutely

Greater than 70     Indicates severe depression. You should be talking to someone immediately
50 to 70                   You are moving into a potentially dangerous state of anxiety &/or depression.
30 to 50                   Some self care required
Less than 30           Pretty normal

• I have trouble starting even the simplest things
• I aren’t able to do most things quickly
• Its not easy for me to concentrate
• I feel agitated and am unable to sit still or do things for a period of time
• I find making decisions difficult
• I usually worry about all sorts of stuff
• I experience little pleasure and/or joy from day to day
• I don’t feel good when I wake up in the morning
• I have lost interest in most aspects of my life
• I don’t see an exciting future ahead
• I don’t feel happy even when good things happen to me
• I usually feel lethargic and tired
• I don’t feel that I deserve to be happy
• I feel like a failure
• I don’t talk to, contact, or see my friends regularly anymore
• I generally sleep badly at night
• I think about suicide or how I might kill myself
• I feel overwhelmed regards commitments to life, work and family
• I have lost or gained weight
• I often feel I ‘need’ a drink or cigarette to calm myself
• I feel tension or anxiety in the pit of my stomach