Basic Information(optional)

Name : __________

Sex: □ Male □ Female □ Do not wish to disclose

Age: __________

Occupation: __________

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Emotional state

During the past two weeks, have you often felt depressed or frustrated?

□ Hardly ever

□ Sometimes

□ Often

□ Almost always

Have you lost interest or pleasure in your daily activities?

□ Not at all

□ Occasionally

□ Often

□ Almost always

Do you feel low energy or easily fatigued?

□ Rarely

□ Sometimes

□ Often

□ Always

Cognitive and Behavioral

Do you often feel that your thinking is slow and you have difficulty concentrating?

□ Hardly ever

□ Sometimes

□ Often

□ Almost always

Do you often feel self-conscious, useless or hopeless?

□ Hardly ever

□ Sometimes

□ Often

□ Almost always

Do you often avoid socializing or interacting with others?

□ Hardly ever

□ Sometimes

□ Often

□ Almost always

Physical Symptoms

Do you often experience sleep problems (e.g., difficulty falling asleep, waking up early, or sleeping too much)?

□ Hardly ever

□ Sometimes

□ Often

□ Almost always

Have you noticed a significant change (increase or decrease) in your appetite?

□ No change

□ Slight change

□ Significant change

□ Extreme change

Other

Have you ever had suicidal thoughts or plans?

□ Never

□ Occasionally

□ Often

□ Have a specific plan in the near future

Do you feel that your mood fluctuates greatly, sometimes extremely high, sometimes extremely low?

□ Hardly ever

□ Sometimes

□ Often

□ Almost always

Click through for more self-measurement scales and a variety of mood tests to help you get inside!

Thank you for taking the time to complete this questionnaire. Please remember that if you or someone you know is experiencing any form of emotional distress, please seek professional help promptly.