In the past two weeks, including today, which statement best describes the way you have been feeling ?

    1. *Sadness: Do you feel sad or down in the dumps?

    2. *Discouragement: Does your future look hopeless?

    3. *Low Self-Esteem: Do you feel worthless?

    4. *Inferiority: Do you feel inadequate or inferior to others?

    5. *Guilt: Do you get self-critical and blame yourself?

    6. *Indecisiveness: Is it hard to make decisions?

    7. *Irritability: Do you frequently feel angry or resentful?

    8. *Loss of interest in life: Have you lost interest in your career, hobbies, family and friends?

    9. *Loss of motivation: Do you have to push yourself to do things?

    10. *Poor Self-Image: Do you feel old and unattractive?

    11. *Appetite Changes: Have you lost your appetite? Do you overeat or binge compulsively?

    12. *Sleep Changes: Is it hard to get at good night's sleep? Are you excessively tired and sleeping too much?

    13. *Loss of Libido: Have you lost your interest in sex?

    14. *Concerns about Health: Do you worry excessively about your health?

    15. *Suicidal Impulses: Do you have thoughts that life is not worth living or think you'd be better off dead?

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